Outpatient Management of Severe COPD

Abstract

A 67-year-old man presents with progressive dyspnea. He has smoked cigarettes since he was 15 years of age. Worsening breathlessness forced him to retire as a laborer. His physical examination is notable for distant breath sounds on auscultation, with a prolonged expiratory phase. Spirometry reveals severe airflow obstruction (ratio of forced expiratory volume in first second [FEV1 ] to forced vital capacity, 0.43; FEV1 , 34% of the predicted value). How should this case be managed?