18th January 2024

A 45-year-old smoker is admitted to hospital with a 7-day history of increasing breathlessness, thick yellow-green coloured sputum and rigors.

A 45-year-old smoker is admitted to hospital with a 7-day history of increasing breathlessness, thick yellow-green coloured sputum and rigors. She has already started her rescue pack for COPD, but it has made no significant difference. In hospital, she is currently being treated for an infective exacerbation of her COPD, and her ABGs are showing worsening type 2 respiratory failure. You are asked to review her regular medication:

Methotrexate 12.5mg once weekly 

Hydroxychloroquine 200mg OD

Prednisolone 2mg OD 

Metformin 1000mg BD 

Salbutamol 200microgram PRN

Glycopyrronium bromide 44 microgram OD

Which of the following medication changes, if any,  would be more appropriate?

Select the SINGLE most appropriate option from the list below. Select ONE option only.