RT is a 65 year old female with moderate chronic obstructive pulmonary disease (COPD). Despite using inhaled salbutamol, she continues to have symptoms of difficulty breathing and is currently at the emergency department. What inhaled medication should be added to help her manage her persistent symptoms?
a) terbutaline b) ipratropium c) fluticasone d) tiotropium
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(D) is the answer.
For a patient with moderate COPD, the next ideal step would be selecting a long-acting bronchodilator such as tiotropium to manage her persistent symptoms.
Terbutaline is a short acting beta agonist which is in the same therapeutic family as salbutamol and should not be used.
Ipratropium is a short acting muscarinic agent which could be added for extra bronchodilation in mild cases, but this patient has moderate COPD and requires a longer acting agent.
Fluticasone is an inhaled corticosteroid which is reserved as last line. It is preferred to maximize use with long-acting bronchodilators first before using fluticasone.
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