If on ICS LAMA LABA triple tx Consider removing ICS if pneumonia or other considerable ADRs If eos 300 cells L de escalation is more likely to lead to exac If FEV1

<b>If on ICS+LAMA+LABA triple tx:</b> Consider removing ICS if pneumonia or other considerable ADRs. If eos ≥300 cells/µL, de-escalation is more likely to lead to exac. If FEV₁ <50% w/ chronic bronchitis, consider roflumilast (improves lung fxn, reduces exac [A]); if not a current smoker, consider azithromycin (reduces exac [A]but increases bacterial resistance [A]and impairs hearing [B]).