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| * copd |
| | #178578 |
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A 57-year-old woman is discharged from the hospital after an exacerbation of COPD. She has finished a course of antibiotics, and her current regimen includes salmeterol 2 puffs twice per day, albuterol 2 puffs every 6 hours as needed, and a tapering dose of prednisone. She has had COPD exacerbations 2 to 3 times per year for the last 2 years. She quit smoking 3 years ago, received a dose of pneumococcal vaccine 3 years ago, and had a flu shot this year. Her most recent spirometry showed FEV1 of 1.1 L (45% of predicted) with no significant bronchodilator response. Her oxygen saturation on room air is 90%, and she has no signs of cor pulmonale. Which of the following is the best management option for this patient?
a. Arrange home oxygen therapy
b Perform a PPD skin test
c. Maintain the patient on chronic oral prednisone
d. Add an inhaled corticosteroid
e. Start therapy with oral theophylline
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| * Re:copd |
| #740450 |
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Add an inhaled corticosteroid. Regular treatment with inhaled corticosteroids has been shown to reduce the frequency of exacerbations and improve health status in symptomatic COPD patients with an FEV1 < 50% predicted and repeated exacerbations (eg, 3 or more in the last 3 years). Long-term treatment with oral corticosteroids is not recommended in COPD.2 Theophylline is effective in COPD but is not a preferred drug due to its potential toxicity. There is no evidence that theophylline reduces the frequency of exacerbation. Long-term oxygen therapy is indicated for patients with very severe COPD who have a Pao2 at or below 55 mm Hg or Sao2 at or below 88%, or, if there is evidence of cor pulmonale or polycythemia (hematocrit > 55%), Pao2 between 55 and 60 mm Hg or Sao2 of 89%.
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