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? Inhaled corticosteroids Long-term oral corticosteroids Inhaled ipratropium Smoking cessation Click here to compare your answer. 2. Which of the following is the best management option for this patient? Inhaled ipratropium as needed Inhaled albuterol as needed A short-acting bronchodilator as needed and regular treatment with a long-acting bronchodilator An inhaled corticosteroid Click here to compare your answer.		3. Which of the following statements regarding corticosteroid therapy in patients with an exacerbation of chronic obstructive pulmonary disease (COPD) is true? Systemic corticosteroids should be given for more than 2 weeks to prevent treatment failure Systemic corticosteroids improve survival Intravenous therapy is better than oral therapy Systemic corticosteroids reduce hospital stays by 1 to 2 days Click here to compare your answer. 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? Arrange home oxygen therapy Perform a PPD skin test Maintain the patient on chronic oral prednisone Add an inhaled corticosteroid Start therapy with oral theophylline Click here to compare your answer.
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