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ACP InternistMKSAP Quiz: Evaluation for Dyspnea

Thoughts on azithromycin, continuous oxygen therapy, nebulized saline, or pulmonary rehabilitation to help this patient.

A 79-year-old male patient is evaluated for insidiously worsening dyspnea over the past year. He has an 8-year history of severe COPD, with no exacerbations in the past year. His medication regimen includes inhaled aclidinium, inhaled formoterol, and inhaled fluticasone propionate, and he demonstrates good inhaler technique. Physical examination shows normal vital signs and an oxygen saturation of 94% on ambient air at rest and with ambulation. Breath sounds are diminished bilaterally, with no other abnormal findings.

Pulmonary rehabilitation programs have been shown to improve not just physical symptoms but also emotional well-being, making them a holistic approach to COPD management.

Treatment Options:
  • Option A: Azithromycin
    • Azithromycin is a macrolide antibiotic that has been studied for its role in reducing COPD exacerbations. It can be given daily or three times weekly and may positively affect quality of life in certain populations.
  • Option B: Continuous Oxygen Therapy
    • Continuous oxygen therapy has been shown to reduce mortality in COPD patients experiencing hypoxia. It is often used in patients with low oxygen levels to improve quality of life and reduce symptoms.
  • Option C: Nebulized Saline
    • Nebulized saline is commonly used for secretion management in patients with sputum production, cough, and problematic secretions. It can be a part of a broader treatment plan for respiratory conditions.
  • Option D: Pulmonary Rehabilitation
    • Pulmonary rehabilitation is a comprehensive intervention designed to improve dyspnea, exercise capacity, and quality of life in patients with respiratory conditions. It often includes exercise training, education, and behavioral intervention.

Which of the above is the most appropriate treatment for this patient?

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