A 55-year-old man with severe chronic obstructive pulmonary disease is evaluated after being discharged from the hospital following an acute exacerbation. He has had 3 exacerbations over the previous 18 months. He is a long- term smoker who quit smoking 1 year ago. His medications are salbutamol as needed and inhaled tiotropium and salmeterol. On examination, vital signs are normal. Breath sounds are decreased bilaterally. Oxygen saturation after exertion is 92% on ambient air. Spirometry shows an FEV1 of 32% of predicated and an FEV1/FVC ratio of 40% Which of the following medications should be initiated now?
سؤال مجاني 1 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. An inhaled corticosteroid
He is a frequent exacerbator (3 in 18 months, severe FEV1 32%) despite LAMA + LABA. The next step is to add an ICS (triple therapy), especially if eosinophils ≥100 cells/µL. Ipratropium duplicates tiotropium. Long-term oral prednisone is not used in stable COPD, and NAC is not the recommended add-on here.
ليش كل خيار صح أو غلط
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A
ليش صح
With persistent exacerbations on LABA/LAMA, the next step is to add an ICS (or change to LAMA/LABA/ICS triple therapy) when eosinophils are ≥ 100 cells/mcL.
✓ COPD.pdf · p. 8 -
B
ليش غلط
Ipratropium is a short-acting muscarinic antagonist, the same class as the tiotropium (LAMA) he already takes, so it adds no new mechanism.
✓ Step Up To Medicine 6th Edition 2024 (COPD).pdf · p. 7 -
C
ليش غلط
The follow-up add-ons for persistent exacerbations on LAMA/LABA are an ICS (eosinophils ≥ 100) or a macrolide / PDE4 inhibitor (< 100); N-acetylcysteine is not among them.
✓ COPD.pdf · p. 8 -
D
ليش غلط
Systemic steroids are used only for acute exacerbations, not long-term treatment, even in severe COPD.
✓ Step Up To Medicine 6th Edition 2024 (COPD).pdf · p. 9
- المصدر
- COPD.pdf · p. 8
Step Up To Medicine 6th Edition 2024 (COPD).pdf · p. 9 - المحاضرة
- COPD · Pulmonology · Module B
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- Respi bank