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COPD exacerbation — MCCQE Part 1 MCQ

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ModerateWheezingCOPD exacerbationMCCQE Part 1

A 69-year-old man with COPD and a 45-pack-year smoking history presents with increased dyspnoea, wheeze and purulent sputum for 3 days. Oxygen saturation is 86% on room air and he is using accessory muscles. Which of the following is the most appropriate initial management?

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Correct answer: E — Controlled oxygen targeting 88-92%, inhaled bronchodilators, systemic corticosteroids and antibiotics if bacterial features are present

COPD exacerbation with hypoxaemia requires controlled oxygen, bronchodilators and systemic corticosteroids, with antibiotics when sputum purulence or severe exacerbation suggests bacterial infection. Uncontrolled high-flow oxygen can worsen hypercapnia in susceptible patients, while withholding oxygen is unsafe. Inhaled steroid alone and cough suppression do not treat the acute physiology.

Reference: Canadian Thoracic Society COPD guideline