Question

A 72-year-old man with a 40-pack-year smoking history presents with increased dyspnoea and sputum production for 5 days. He has known moderate COPD (FEV₁ 55% predicted) and usually uses a long-acting muscarinic antagonist (LAMA) and a long-acting beta₂-agonist (LABA) inhaler. He is afebrile but wheezy with mild respiratory distress. SpO₂ is 91% on room air. What is the most appropriate initial management in the emergency department?

Accepted Answer

Administer inhaled Salbutamol and ipratropium plus a short course of systemic corticosteroids, and consider antibiotics based on sputum purulence and severity

Answer

Start high-dose inhaled corticosteroids alone and avoid systemic steroids

Answer

Give broad-spectrum intravenous antibiotics to all patients with COPD exacerbations regardless of sputum changes

Answer

Withhold bronchodilators to avoid worsening ventilation-perfusion mismatch

Answer

Intubate immediately because his SpO₂ is <94%

Practice question