A 65-Year-Old Man with Moderate Chronic Obstructive Pulmonary Disease Comes

A 65-year-old man with moderate chronic obstructive pulmonary disease comes to the physician complaining of a dry cough over the past week.  He has no fever, chills, night sweats, or weight loss, but the cough has kept him awake at night.  The patient has been using his rescue albuterol 3 times a day.  Pulmonary function testing a month ago showed a forced expiratory volume in 1 second of 53% of predicted, a forced vital capacity of 64% of predicted, and FEV₁/FVC ratio of 0.56.  His past medical history also includes hypertension and hyperlipidemia.  His other medications include budesonide/formoterol, tiotropium, long-acting nifedipine, and simvastatin.
His temperature is 37 C (98.6 F) , blood pressure is 120/80 mm Hg, pulse is 89/min, and respirations are 18/min.  Pulse oximetry is 97% on room air.  Examination shows a thin, elderly man in no significant respiratory distress but with frequent cough.  There is good air entry with diffuse bilateral wheezes in all lung fields and scattered coarse breath sounds that clear with cough.
Posteroanterior and lateral chest x-rays reveal no infiltrates.  His white blood cell count is 6,700/µL with normal differential.
Which of the following is the best next step in management of this patient?

A) Add inhaled ipratropium and follow up closely
B) Admit to the hospital for intravenous antibiotics and glucocorticoids
C) Reassure and continue current care with close follow-up
D) Start oral antibiotics with close follow-up
E) Start oral glucocorticoids with close follow-up

Correct Answer:

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