A 74-Year-Old Man Comes to the Physician Because of Daily

question 731

Multiple Choice

A 74-year-old man comes to the physician because of daily productive cough with yellowish sputum and dyspnea on exertion.  His past medical history includes chronic obstructive pulmonary disease, type 2 diabetes mellitus, hypertension, and hyperlipidemia.  Over the last 6 months, he has had 2 hospital admissions for respiratory distress.  The most recent admission was 2 months ago, when he was treated with IV corticosteroids and bronchodilators via nebulizer.  His medications include formoterol and tiotropium.  The patient's dyspnea has improved since discharge but he is short of breath with exertion.  He has lost 10 lb (4.5 kg) over the last 6 months.  He stopped smoking 7 years ago but has a 60-pack-year history.
Pulse oximetry is 93% on room air.  He is notably dyspneic after walking down the hall.  Physical examination shows a thin man with bitemporal wasting.  His chest is barrel shaped.  There is mild diffuse expiratory wheezing on lung examination.
Pulmonary function testing is significant for FEV₁ 35% of predicted, FVC 55% of predicted, FEV₁/FVC 63%, and lung diffusion capacity testing 43% of predicted.  Chest x-ray reveals hyperinflation.
Inhaled corticosteroids are added to his regimen during this clinic visit.
Which of the following do inhaled corticosteroids increase?

• A)All-cause mortality
• B)Cardiovascular mortality
• C)COPD exacerbations
• D)Lung cancer risk
• E)Pneumonia incidence

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