QuestionSBA
QuestionChoice
Long-term oxygen therapy is reserved for patients with severe resting hypoxaemia (resting O2 <93%) who are non-smokers. It would not be indicated in this patient at this time.
10006834
d
Initiate long-term oxygen therapy
QuestionChoice
A LABA and ICS would be initiated in patients with asthmatic features or features suggesting steroid responsiveness when symptoms continue despite treatment with a SABA/SAMA. This patient does not have any asthmatic features or evidence of steroid responsiveness. Therefore, it is more appropriate to start this patient on a LABA and LAMA initially.
10006832
b
Add LABA + ICS
QuestionChoice
A leukotriene receptor antagonist (LTRA) is used in the treatment of asthma following the use of an ICS and LABA. It does not currently have a role in the treatment of COPD.
10006835
e
Add leukotriene receptor antagonist
QuestionChoice
According to NICE guidance, if a patient continues to be limited by symptoms of COPD or experiences exacerbations despite treatment with a SABA or SAMA, and no asthmatic features are present, the patient should be offered a LABA AND a LAMA. This patient has uncontrolled symptoms despite regular use of her salbutamol inhaler. She has no past medical history of asthma, and her use of bisoprolol - which is contraindicated in asthmatic patients - confirms this. The correct next step would be to commence the patient on a LABA and a LAMA. An ICS may be added to this regime later if symptoms continue despite treatment.
10006831
a
Add LABA + LAMA
QuestionChoice
Inhaled corticosteroids (ICS) make up the second-line treatment for asthma, and are used in addition to LABAs and LAMAs in COPD management, particularly in those with asthmatic features. It would not be appropriate to prescribe an ICS alone to this patient.
10006833
c
Add inhaled corticosteroid
Concept
Chapter
2693
3717
Chronic obstructive pulmonary disease (COPD)
Topic
132
Respiratory
13913
An 81-year-old woman presents to her GP complaining of worsening breathlessness. She has a diagnosis of chronic obstructive pulmonary disease (COPD) and currently takes a salbutamol inhaler as needed. She is now having to take this multiple times each day, with little improvement in symptoms. She has a past medical history of atrial fibrillation, for which she has taken bisoprolol for two years. Spirometry reveals an FEV1/FVC 0.5. Oxygen saturations are 95%.
The GP decides to amend her current regime to improve her symptoms.
Which of the following medication changes would be most appropriate to make in this patient?
a