A 60-year-old man has had a chronic cough with clear sputum production for over 5 years. He has smoked one pack of cigarettes per day for 40 years and continues to do so. X-ray of the chest shows hyperinflation without infiltrates. Arterial blood gases show pH of 7.38, P CO2 of 40 mm Hg, PO2 of 65 mm Hg, O2 saturation of 93%. Spirometry shows an FEV1 /FVC of 45% without bronchodilator response. Which of the following is the most important treatment modality for this patient?
A. Oral corticosteroidsThis patient’s chronic cough, hyperinflated lungs, abnormal pulmonary function tests, and smoking history are all consistent with chronic bronchitis. A smoking cessation program can decrease the rate of lung deterioration and is successful in as many as 40% of patients, particularly when the physician gives a strong antismoking message and uses both counseling and nicotine replacement. Continuous low-flow oxygen becomes beneficial when resting arterial oxygen saturation falls below 88%. Inhaled beta agonists or anticholinergics such as ipratropium or tiotropium are the cornerstones of symptomatic therapy but do not prevent progression of airways obstruction if the patient continues to smoke. Antibiotics are indicated only for acute exacerbations of chronic lung disease, which present with fever, change in sputum color, and increasing shortness of breath. Oral corticosteroids are helpful in acute exacerbations, but their side-effect profile precludes chronic use. Theophylline is a fourth-line treatment in COPD.