Scenario #4: Patient on LABA + LAMA + ICS
✓ Consider daily roflumilast if FEV1 <50% and chronic bronchitis
✓ Consider azithromycin, especially in ex-smokers
✓ Consider de-escalation of ICS if pneumonia or other considerable side effects; if BEC ≥300 cells/μL, de-escalation is more likely to be associated with exacerbations
✓ Review and reassess response