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Discussion Starter · #1 ·
A 70-year-old smoker with a 50 pack-year smoking history is currently using a daily disk inhaler that delivers salmeterol and fluticasone.
In addition, she has been recently discharged from the hospital for a chronic obstructive pulmonary disease (COPD) exacerbation and is being tapered off her 2-week course of oral prednisone. At one point, heophylline was added to her regimen during the inpatient stay and she was sent home with a prescription for supplemental oxygen to be delivered for 12 hours during the night. Which of the agents that this patient is currently taking has been shown to decrease overall mortality in patients with COPD?
(A) Inhaled glucocorticoids
(B) Salmeterol
(C) Supplemental oxygen
(D) Theophylline
 

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Discussion Starter · #4 ·
Correct Answer

The correct answer is C. Supplemental oxygen is the only therapy demonstrated to decrease mortality in patients with chronic obstructive pulmonary disease. For patients with resting hypoxemia (resting arterial oxygen saturation < 88%, or < 90% with signs of pulmonary hypertension or right heart failure), the use of oxygen has been demonstrated to have a significant impact on mortality. The Medical Research Council Trial demonstrated that 12 hours per day was superior to no oxygen supplementation, but continuous oxygen was even better.

Answer A is incorrect. Several recent trials have failed to find a beneficial effect for the regular use of inhaled glucocorticoids on the rate of decline of lung function, as assessed by forced expiratory volume in 1 second.

Answer B is incorrect. Although chronic obstructive pulmonary disease (COPD) is characterized by airway inflammation/obstruction that is largely irreversible, salmeterol given in the acute setting can be used to improve any component of airway constriction that is reversible. No studies have shown that it affects overall mortality in COPD.

Answer D is incorrect. Theophylline has not be shown to decrease mortality in chronic obstructive pulmonary disease.
 
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