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Chapter 45. Chronic Obstructive Pulmonary Disease

AF is a 59-year-old man who currently smokes and has recently been diagnosed with chronic obstructive pulmonary disease (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? Select all that apply.

a. Short-acting bronchodilator

b. Long-acting muscarinic antagonist

c. Long-acting β-agonist

d. Inhaled corticosteroid

e. Oral theophylline

Answer a is correct. According to the GOLD guidelines, a bronchodilator should be given to patients Group A. The short-acting bronchodilators most commonly used are albuterol and ipratropium.

Note: All patients benefit from using a spacer device or valved holding chamber when using a metered-dose inhaler.

Answer b is correct. A long-acting muscarinic antagonist can be used as monotherapy in Group A.

Answer c is correct. A long-acting β-agonist can be used as monotherapy for a patient in Group A.

Answer d is incorrect. Inhaled corticosteroids are recommended in patients with continued exacerbations despite treatment with long-acting bronchodilators. In symptomatic patients with COPD and frequent exacerbations, regular treatment with inhaled corticosteroids decreases the number of exacerbations per year and improves health status; however, corticosteroid therapy does not slow the long-term decline in pulmonary function.

Answer e is incorrect. Theophylline is only recommended when other bronchodilators are unavailable or unaffordable. This is primarily due to the narrow-therapeutic index and close monitoring required as a result of complex pharmacokinetics and numerous drug–drug interactions. Theophylline also has significant adverse effects.

Which of the following are indicated for the management of chronic obstructive pulmonary disease (COPD)? Select all that apply.

a. Fluticasone and Salmeterol

b. Formoterol

c. Montelukast

d. Umeclidinium

Answer c is incorrect. Leukotriene receptor antagonists are only indicated for asthma, not COPD.

Answer a is correct. Inhaled corticosteroids are recommended in patients with continued exacerbations despite treatment with long-acting bronchodilators.

Answer b is correct. Long-acting β-agonists can be used as monotherapy for COPD.

Answer d is correct. Long-acting muscarinic antagonists can be used as monotherapy for COPD.

Which of the following are advantages of using a spacer device with a metered-dose inhaler? Select all that apply.

a. Decreased oropharyngeal deposition

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