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Self-Assessment Questions

Pulmonary Disease

Management of Chronic Obstructive Pulmonary Disease: Review Questions

Yuji Oba, MD, FCCP

Dr.Oba is an assistant professor on medicine, University of Missouri-Kansas City, Kansas City, MO.

Choose the single best answer for each question.

Questions 1 and 2 refer to the following case study.

A 65-year-old man presents to his physician’s office with a 6-month history of wheezing, dyspnea on exertion, and daily sputum production. He is a 50 pack-year smoker but is otherwise healthy. Examination shows markedly decreased breath sounds with mild wheezing at the end of expiration. When spirometry is performed, his forced expiratory volume in 1 second (FEV1) is 1.5 L (60% of predicted). His forced vital capacity (FVC) is 2.3 L. The FEV1/FVC ratio is 0.65.

1. Which of the following interventions will be most effective for improving this patient’s long-term survival?
  1. Inhaled corticosteroids
  2. Long-term oral corticosteroids
  3. Inhaled ipratropium
  4. Smoking cessation
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2. Which of the following is the best management option for this patient?

  1. Inhaled ipratropium as needed
  2. Inhaled albuterol as needed
  3. A short-acting bronchodilator as needed and regular treatment with a long-acting bronchodilator
  4. An inhaled corticosteroid
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3. Which of the following statements regarding corticosteroid therapy in patients with an exacerbation of chronic obstructive pulmonary disease (COPD) is true?
  1. Systemic corticosteroids should be given for more than 2 weeks to prevent treatment failure
  2. Systemic corticosteroids improve survival
  3. Intravenous therapy is better than oral therapy
  4. Systemic corticosteroids reduce hospital stays by 1 to 2 days
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4. 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?

  1. Arrange home oxygen therapy
  2. Perform a PPD skin test
  3. Maintain the patient on chronic oral prednisone
  4. Add an inhaled corticosteroid
  5. Start therapy with oral theophylline
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