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A 64-Year-Old Woman Comes to the Office for Follow-Up

question 552

Multiple Choice

A 64-year-old woman comes to the office for follow-up. She was diagnosed with chronic obstructive pulmonary disease (COPD) 4 years ago. She initially used albuterol as needed but was started on daily tiotropium a year ago. The patient reports a mild cough and shortness of breath with exertion, which somewhat limits her daily activities. She has no dyspnea or chest pain at rest. She had 3 COPD exacerbations last year but has never been hospitalized, and she has never undergone endotracheal intubation. The patient quit smoking when she was diagnosed with COPD. She received both pneumococcal and annual influenza vaccinations. Her other medical problems include osteoarthritis of the knees and hypertension.
Vital signs are normal. Oxygen saturation at rest is 95% on room air but 90% on room air after a 6-minute walk. BMI is 29 kg/m². Examination reveals decreased breath sounds bilaterally with no wheezing or crackles. There is no jugular venous distension or peripheral edema.
Pulmonary function testing reveals an FEV1/FVC ratio of 62% and an FEV1 55% of predicted. Chest x-ray shows mild hyperinflation but no infiltrates.
Which of the following is the most appropriate next step in management of this patient?

Definitions:

Sarah Grimké

An American abolitionist and advocate for women's rights who, along with her sister Angelina, played a pivotal role in the women's suffrage movement.

Separate Spheres

A 19th-century ideology that men and women have different roles in society, with men dominating the public sphere and women the private, domestic sphere.

Seneca Falls Convention

A pivotal gathering held in 1848 that marked the beginning of the women's suffrage movement in the United States.

Cult Of Domesticity

The nineteenth-century ideology of “virtue” and “modesty” as the qualities that were essential to proper womanhood.