COPD USMLE Step 1 Practice Question
A 62-year-old man with moderate COPD presents with persistent dyspnea during daily activities despite 3 months of tiotropium monotherapy and good adherence. Vital signs: BP 138/82 mmHg, HR 94/min, RR 18/min, SpO2 92% on room air. FEV1 is 58% predicted. Chest X-ray shows no acute infiltrates. He denies orthopnea and has no lower extremity edema. Which pharmacologic agent best represents the next step in management according to GOLD guidelines?
Answer choices
- AAdd a long-acting beta-2 agonist (LABA) to create a dual long-acting bronchodilator combinationCorrect answer
- BAdd theophylline as a second-line agent to potentiate bronchodilation
- CAdd inhaled corticosteroids as monotherapy without additional bronchodilators
- DRefer for lung transplant evaluation given persistent symptoms on long-acting therapy
- ESwitch to short-acting bronchodilators only due to beta-blocker contraindication concerns
- FAdd a short-acting beta-2 agonist (SABA) as needed for breakthrough symptoms only
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