MKSAP: 72-year-old woman with severe COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed.
On physical examination, pulse rate is 94/min, and respiration rate is 26/min. Pulmonary examination reveals distant breath sounds and no wheezing. Oxygen saturation is 86% breathing ambient air. Pulmonary function testing reveals an FEV1 of 26% of predicted and an FEV1/FVC ratio of 41%.
Which of the following is the most appropriate next step in management?
A: Oral antibiotics
B: Oxygen therapy
C: Prednisone taper
D: Repeat pulmonary rehabilitation
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Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
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