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A 66-Year-Old Man Comes to the Office Due to Shortness

question 838

Multiple Choice

A 66-year-old man comes to the office due to shortness of breath and cough. Three years ago, he was diagnosed with chronic obstructive pulmonary disease and as needed inhaled albuterol was started. Over the past few months, he has been having worsening shortness of breath and has been using his inhaler more frequently. The patient is an avid golfer and says he has had to stop to catch his breath when walking on the golf course. He has had no chest pain, orthopnea, or leg swelling. The patient has never required urgent medical care for his breathing. His other medical problems include hypertension and hyperlipidemia. The patient has smoked for 50 years and says he has now cut down to 5 cigarettes daily.
Blood pressure is 140/83 mm Hg, pulse is 77/min, and respirations are 16/min. Oxygen saturation on room air is 95% at rest and 90% after walking for several minutes. Lung auscultation reveals good air entry with occasional expiratory wheezes.
Pulmonary function testing shows FEV1 is 54% of predicted, FVC is 68% of predicted, and FEV1/FVC is 61%. Chest radiography reveals no lung infiltrates or masses.
In addition to recommending complete smoking cessation, which of the following is the most appropriate next step in management of this patient?

Definitions:

Conditions

Specific factors or circumstances that affect situations, actions, or phenomena, determining their outcomes or the manner in which they occur.

Dilemmas

Situations that require a choice between options that are or seem equally unfavorable or mutually exclusive.

Crises

Periods of significant change or turmoil in an individual's or group's life, often prompting a need for major decisions or adjustments.

Socialization

The process by which individuals learn and adopt the values, norms, and behaviors that are considered appropriate in their society.