An older man with a history of COPD presents for follow-up after being hospitalized with an acute exacerbation. He asks you what treatments are available to decrease his risk of death.
Which of the following therapies has been shown to reduce longterm mortality in this condition?
A. GuaifenesinHome oxygen therapy. The two most important interventions for reducing mortality in COPD are smoking cessation and home oxygen therapy, provided that the patient meets certain criteria. Patients with an SaO2 ≤88% or PaO2 ≤55 mmHg during rest, exercise, or sleep will benefit from chronic home oxygen therapy with a significant reduction in mortality. The cutoffs are slightly higher in a patient that has polycythemia or cor pulmonale. There are other interventions that show some mortality benefit, but the two interventions mentioned above are the most likely interventions to be tested on the shelf examination. (A) Mucolytics such as guaifenesin may partially reduce symptoms from excess airway secretions; however, there is debate over their usefulness and they do not reduce mortality. (B) Oral prednisone is used in acute exacerbations to reduce airway inflammation, but chronic treatment with systemic steroids has many side effects and can increase mortality. (D) Inhaled ipratropium is useful both in chronic treatment and in acute exacerbations. It decreases symptoms and improves lung function but does not decrease overall mortality.