This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: COPD and Asthma, Subject name: Medicine
Roflumilast is introduced in management of COPD in? 
Select and explain. 
A. Group A, B. Group B, C. Group C, D. Group D
D: Group D
Answer: D: Group D 
Explanation: Group A Low Risk, low symptom Bronchodilator Group B Low Risk, High symptom LABA/LAMA, if failed- LAMA+LABA Group C High Risk, Low symptom LAMA+LABA or LABA+ICS Group D High Risk, High symptom LAMA+LABA+ICS | symptoms persists Phosphodiesterase inhibitor (Roflumilast) or Macrolides