03-03-2009, 05:04 PM
A 72-year-old man is evaluated for progressive dyspnea on exertion and a morning cough productive of thick white sputum. The patient is a life-long cigarette smoker and was diagnosed with chronic obstructive pulmonary disease 4 years ago; he has had two unscheduled office visits in the past 6 months for bronchitis.
On physical examination, he is thin (BMI 20), his chest is hyperinflated, breath sounds are diminished, he has 1+ ankle edema. Spirometry shows an FEV1 35% of predicted which improves 5% with albuterol. Lung volume measurement shows a total lung capacity of 140 % and residual volume of 130%; the DLCO is 55% of predicted.
Which of the following is the most appropriate therapy for this patient?
A Albuterol, tiotropium, and inhaled corticosteroids
B Ipratropium bromide and tiotropium
C Albuterol/ipratropium bromide inhaler, a long-acting β-agonist, and oral corticosteroids
D Ipratropium bromide and montelukast
On physical examination, he is thin (BMI 20), his chest is hyperinflated, breath sounds are diminished, he has 1+ ankle edema. Spirometry shows an FEV1 35% of predicted which improves 5% with albuterol. Lung volume measurement shows a total lung capacity of 140 % and residual volume of 130%; the DLCO is 55% of predicted.
Which of the following is the most appropriate therapy for this patient?
A Albuterol, tiotropium, and inhaled corticosteroids
B Ipratropium bromide and tiotropium
C Albuterol/ipratropium bromide inhaler, a long-acting β-agonist, and oral corticosteroids
D Ipratropium bromide and montelukast