A 65-Year-Old Man with Chronic Obstructive Pulmonary Disease Comes to the Emergency

A 65-year-old man with chronic obstructive pulmonary disease comes to the emergency department with increased dyspnea and worsening cough for the last 2 days.  He has been unable to rest due to increased symptoms.  The patient has increased sputum production compared to his baseline.  He tried 3 nebulizer treatments with albuterol and ipratropium bromide at home with no relief.  His most recent spirometry during an office visit a month ago showed FEV1 of 60% of predicted.  His temperature is 37.2 C (99 F) , blood pressure is 150/90 mm Hg, pulse is 110/min, and respirations are 23/min.  The patient's oxygen saturation is 87% on room air.  He appears to be in mild respiratory distress.  Lung examination shows bilateral wheezing and prolonged expiration.  ECG shows sinus tachycardia.  Chest x-ray reveals a flattened diaphragm and no infiltrates.  Initial laboratory studies show a white blood cell count of 11,000/mm³.  He is started on supplemental oxygen, bronchodilators, and glucocorticoids.  Which of the following additional therapies would also benefit this patient in the acute setting?

A) Antibiotics
B) Chest physiotherapy
C) Fluticasone inhaler
D) Magnesium sulfate
E) No additional therapy
F) Roflumilast

Correct Answer:

Verified

Unlock this answer now
Get Access to more Verified Answers free of charge

Access For Free