American Board of Internal Medicine (ABIM) Certification Practice Exam

According to the FLAME trial, which combination of inhaled medications is superior for reducing COPD exacerbations?

1. Indacaterol and fluticasone

2. Salmeterol and glycopyrrolate

3. Indacaterol and glycopyrrolate

4. Salmeterol and ipratropium

The correct answer is: Indacaterol and glycopyrrolate

The FLAME trial focused on comparing the efficacy of different inhaled medications in reducing exacerbations in patients with Chronic Obstructive Pulmonary Disease (COPD). The significant finding was that the combination of indacaterol, a long-acting beta-agonist (LABA), and glycopyrrolate, a long-acting muscarinic antagonist (LAMA), was more effective in reducing the frequency of COPD exacerbations when compared to other treatment combinations. The rationale behind this superiority is based on the pharmacological actions of the medications involved. Indacaterol works by relaxing the muscles in the airways to improve breathing, while glycopyrrolate helps to decrease secretions and prevent bronchoconstriction. Together, these medications provide a complementary mechanism for managing airflow obstruction and mitigating exacerbation rates. Furthermore, the trial indicated that the LABA/LAMA combination not only reduced exacerbations but also improved lung function and health-related quality of life for COPD patients, making this combination a key therapeutic strategy in COPD management. This combination differentiates itself from other combinations, which may not share the same level of evidence in terms of exacerbation reduction or may focus on alternative management strategies without the same proven effectiveness in this domain. Overall,