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A 72 Year-Old Man with a History of Very Severe

question 651

Multiple Choice

A 72 year-old man with a history of very severe chronic obstructive pulmonary disease (COPD) has increasing dyspnea that initially occurred only with exertion but has become present at rest over the last few years. He has a chronic cough with scant sputum production, which has not changed. The patient has not recently required hospitalization or other acute treatment for COPD exacerbations. He uses supplemental oxygen continuously. Medications include tiotropium, fluticasone/salmeterol, and theophylline. He also uses an albuterol rescue inhaler occasionally, but it provides very little relief. He quit smoking 4 years ago.
Respiratory rate is 20/min and pulse is 94/min. SaO₂ is 92% on oxygen at 3 L/min. Physical examination shows cachexia and pursed lip breathing. There is decreased air entry bilaterally with no wheezes.
Chest x-ray reveals hyperinflation. Forced expiratory volume in 1 second (FEV₁) is 19% predicted, forced vital capacity (FVC) is 56% predicted, and FEV₁/FVC is 0.43.
Which of the following therapies should be considered in this patient?

Definitions:

Alveoli

Tiny air sacs in the lungs where the exchange of oxygen and carbon dioxide takes place, crucial for the respiratory process.

Inspiration

Inspiration refers to the process of being mentally stimulated to do or feel something, especially something creative or the intake of air into the lungs.

Expiration

The act of coming to an end or the cessation of validity, such as in the context of a deadline or a product's shelf life.

Bucc/o

A combining form in medical terminology that refers to the cheek.