Question

Mr. Woods is a 63-year-old man who presents for initial evaluation at your practice. He has a 45 pack-year smoking history and COPD that is currently being treated with daily oral theophylline and albuterol via MDI prn. He complains of shortness of breath and chronic cough with sputum production. He states, "I can barely walk to my car without getting out of breath." Spirometric assessment reveals an FEV1 of 45% predicted and a FEV1:FVC of 62%. His health history reveals 3 exacerbations in the past year. The best course of action for Mr. Woods to minimize COPD exacerbation risk is to:

-Continue on theophylline therapy.
-Advise using albuterol on a set schedule rather than prn.
-Switch to a long-acting beta2-agonist as needed for shortness of breath.
-Add therapy with a long-acting muscarinic antagonist uses on a set schedule.

Answer 1

The best action for Mr. Woods to minimize COPD exacerbation is to add a long-acting muscarinic antagonist (LAMA) to his treatment, used on a set schedule, and encourage smoking cessation to slow COPD progression.

Step-by-step explanation:

In treating Mr. Woods, a 63-year-old man with COPD and a significant smoking history, the best course of action to minimize COPD exacerbation risk is to add therapy with a long-acting muscarinic antagonist (LAMA) used on a set schedule. LAMAs are a mainstay in the management of COPD and have been shown to improve lung function, reduce COPD exacerbations, and enhance quality of life when used regularly as compared to on an as-needed basis. The use of daily LAMA therapy, in combination with his current theophylline and as-needed albuterol regimen, is likely to provide better symptomatic control and reduce exacerbation frequency. Additionally, the cessation of smoking is paramount, as it can slow down the progression of COPD.