Pulmonology Q3


stion 3

A 69-year-old man is evaluated for a 3-year history of dyspnea and chronic productive cough. He was diagnosed with COPD 2 years ago after spirometry confirmed severe airflow obstruction. He discontinued smoking at that time but in the past year he was treated for three COPD exacerbations, one requiring hospitalization. Medications are tiotropium, fluticasone/salmeterol, and albuterol inhalers.

On physical examination, vital signs are normal; oxygen saturation is 92% on ambient air. He intermittently coughs during the examination. He has a prolonged expiratory phase. The remainder of the examination is unremarkable.

Chest radiograph shows the lungs to be clear.

Spirometry demonstrates a postbronchodilator FEV1 of 45% of predicted.

Which of the following long-term treatments is most likely to reduce this patient's exacerbations of COPD?

1. Prednisone

2. Roflumilast 

3. Theophylline

4. Trimethoprim-sulfamethoxazole


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