A patient with COPD on LABA, LAMA and ICS has an ABG showing chronic respiratory acidosis and PaO₂ 56 mmHg. Oxygen saturation is 86%. There is no cor pulmonale and no sign of heart failure. What should be added?
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الإجابة: C. Long-term oxygen therapy
LTOT is indicated in stable COPD with PaO2 at or below 55 mmHg or SaO2 at or below 88% at rest (or PaO2 55-60 with pulmonary hypertension, CHF or polycythaemia). Here PaO2 56 alone would not qualify without cor pulmonale, but SpO2 86% meets the saturation criterion, so add long-term oxygen, which improves survival. NIV/azithromycin/transplant are not the indicated next step.
ليش كل خيار صح أو غلط
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A
ليش غلط
Lung transplantation is reserved for very severe COPD in patients not eligible for bullectomy or lung volume reduction; it is not the next add-on for this patient.
✓ COPD.pdf · p. 9 -
B
ليش غلط
Long-term NIV may be considered only in select patients with severe chronic hypercapnia. His saturation of 86% meets the LTOT criterion (SaO2 ≤ 88% at rest), and LTOT increases survival in severe resting hypoxemia.
✓ COPD.pdf · p. 9 -
C
ليش صح
LTOT is indicated for SaO2 ≤ 88% or PaO2 ≤ 55 mmHg at rest, and it increases survival in severe resting hypoxemia. His SaO2 is 86%.
✓ COPD.pdf · p. 9 -
D
ليش غلط
A macrolide such as azithromycin is added to LABA/LAMA/ICS when the problem is persistent exacerbations. No exacerbations are described here; his problem is resting hypoxemia.
✓ COPD.pdf · p. 8
- المصدر
- COPD.pdf · p. 9
5• COPD [Slides].pdf · p. 3 - المحاضرة
- COPD · Pulmonology · Module B
- ظهر في
- MED42 Compre B