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Chapter 44: Chronic Obstructive Pulmonary Disease

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A patient presents with symptoms of shortness of breath, nonproductive cough and the following spirometry results: prebronchodilator FEV1: 69% predicted; postbronchodilator FEV1: 70% predicted; FEV1/FVC ratio: 0.64. How would you interpret these findings?

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a. This patient has COPD with reversible airway obstruction

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b. This patient has COPD with irreversible airway obstruction

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c. This patient has asthma with reversible airway obstruction

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d. This patient does not have asthma since the airway obstruction is irreversible

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e. This patient does not have COPD or asthma

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Answer b is correct. This patient does have COPD, which is irreversible since the predicted FEV1 did not change with administration of a bronchodilator.

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Answer a is incorrect. This patient does have COPD (an irreversible condition), and it is not reversible since the predicted FEV1 did not change with administration of a bronchodilator.

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Answer c is incorrect. This patient does not have asthma, since airway obstruction in this patient was irreversible (demonstrated by the lack of change in FEV1 postbronchodilator).

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Answer d is incorrect. This patient does not have asthma, since airway obstruction is reversible.

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Answer e is incorrect. This patient does have COPD, patient has a FEV1/FVC ratio less than 0.7.

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AF is a 59-year-old African American man who currently smokes and has recently been diagnosed with COPD. He currently is classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines as patient group A. Which of the following would be recommended as the first-line treatment for AF?

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a. Short-acting bronchodilator

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b. Long-acting anticholinergic

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c. Long-acting β-agonist

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d. Inhaled corticosteroid

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e. Oral theophylline

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Answer a is correct. According to the GOLD guidelines, a short-acting bronchodilator PRN should be given to those in patient group A. An example of the short-acting bronchodilator would be albuterol or levalbuterol. These β2-agonists are similar in mechanism and dosing. Along with the short-acting bronchodilator should be a spacer.

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Note: All patients should utilize a spacer device or valved holding chamber when using a metered-dose inhaler; in addition, face masks should be used in children less than 4 years of age.

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Answer b is incorrect. A long-acting anticholinergic (tiotropium) can be added in patient group B. Ipratropium (Atrovent) is a short-acting anticholinergic and is often used in ...

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