QuestionSBA
QuestionChoice
This would be inappropriate for a few reasons. Firstly, the patient is still smoking which creates a risk of fire. Secondly, we do not know if this patient would benefit from additional oxygen. They have airway obstruction but no signs of hypoxia such as cyanosis or chronically low oxygen saturations.
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d
Refer to receive long-term oxygen therapy
QuestionChoice
This is a very invasive procedure which should not be used so early in this patient's journey. Trialling non-pharmacological and medical management options first is more appropriate.
10027742
b
Refer to thoracic surgeons for lung volume reduction surgery
QuestionChoice
This may be considered as a next step in pharmacological management, as the patient is not benefiting from salbutamol alone. However, offering smoking cessation advice and services is more important.
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c
Add in a tiotropium inhaler once daily
QuestionChoice
This is the single most important management step as smoking cessation is the most effective way of reducing the decreasing lung function in these patients.
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a
Offer smoking cessation advice
QuestionChoice
This may be a good next step for the pharmacological management of this patient's COPD. However, smoking cessation is more important in the first instance as it will slow the progression of the disease.
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e
Add in an inhaled corticosteroid inhaler (e.g. Beclomethasone)
Concept
Chapter
2693
3717
Chronic obstructive pulmonary disease (COPD)
Topic
132
Respiratory
17946
A 56-year-old man presents for a review. He was diagnosed with chronic obstructive pulmonary disorder (COPD) last year. He feels his breathlessness is getting worse despite the use of his salbutamol inhaler. He is currently still smoking and has a 30-pack-year smoking history.

Which management option is the most important?
a