Quiz #85 COPD, diagnosis, treatment, and nihilism
Test your knowledge on COPD
Mr. T is a 64 year-old man with coronary artery disease, benign prostatic hyperplasia and urinary incontinence, who presents to the Pulmonary clinic at Kashlak with shortness of breath. He has had a cough with mucus production for the last several years that occasionally worsens when he has a cold. He is currently smoking, but is cutting back, admitting to an 80 pack-year history. He has been hospitalized for “asthma” 3 times in the last year, and treated with antibiotics. He is able to walk two blocks before becoming short of breath. His resting O2 saturation is 93%. He has an albuterol inhaler that he uses once a day. Of the following, what is the most appropriate diagnostic adjunct to obtain after completing a thorough history and physical exam?
High-resolution non-contrast CT of the chest
Refer for bronchoprovocation testing (“methacholine challenge test”)
No further testing, empirically provide combination long-acting-bronchodilator and inhaled steroid therapy and follow up in clinic
Mr. T is sent for spirometry. His flow-volume loop is shown below in blue. Therapy with a short acting bronchodilator is administered and the resultant flow-volume loop is unchanged from what is demonstrated below. Additionally, it is calculated that his FEV1 is 38% of predicted. What is the most appropriate way to interpret these findings, in the context of the patient’s history?
Restrictive lung disease
Reversible obstruction consistent with asthma
Irreversible obstruction consistent with COPD (GOLD Class 1)
Fixed obstruction concerning for an obstructive mass
Irreversible obstruction consistent with COPD (GOLD Class 3)
Flow volume loop
You have diagnosed Mr. T with COPD based upon his history, exam and using spirometry as a tool. Now it’s time for treating him! Which of the following options represents the best approach to initial therapy in this COPD patient (GOLD Class 3)?
Pulmonary rehabilitation, LABA/LAMA, continue SABA as needed and encourage smoking cessation ASAP
Start LAMA/ICS therapy and a SAMA, continue SABA as needed, and encourage smoking cessation ASAP with pulmonary rehabilitation
Low-dose oral steroid therapy and SABA for breakthrough symptoms, encourage smoking cessation ASAP
Oxygen, ICS and encourage smoking cessation ASAP
LABA/LAMA, continue SABA, encourage smoking cessation ASAP and prescribe azithromycin three times weekly with pulmonary rehabilitation
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