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Self-Assessment Questions

Pulmonary Disease

Answer 2
  1. A short-acting bronchodilator as needed and regular treatment with a long-acting bronchodilator. This patient has moderate COPD (FEV1/FVC < 70%; 50% of predicted ≤ FEV1 < 80% of predicted) according to the revised GOLD (Global Initiative for Chronic Obstructive Lung Disease) guidelines.2 The GOLD guidelines suggest regular treatment with a long-acting bronchodilator, such as salmeterol or formoterol, plus a short-acting bronchodilator as rescue medication in this category. Inhaled corticosteroids are indicated in symptomatic COPD patients with severe COPD (FEV1 < 50% of predicted) and repeated exacerbations (eg, 3 or more in the past 3 years). A short-acting bronchodilator can be used on an as-needed basis in mild COPD (FEV1 > 80 % of predicted) if patients are symptomatic.

    1. Anthonisen NR, Connett JE, Kiley JP, et al. Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA 1994;272:1497-505.
    2. GOLD executive summary (updated 2003). Available at www.goldcopd.com/es.html. Accessed 21 Apr 2004.
    3. Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med 1999; 340:1941-7.

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