skip to main content

Home oxygen in COPD — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePulmonary/Critical CareHome oxygen in COPDABIM Board

A 68-year-old man with COPD has completed pulmonary rehabilitation and is receiving optimized inhaled therapy. He has had no exacerbations for 3 months. On two outpatient assessments 3 weeks apart, while resting and breathing room air, his PaO2 is 54 mm Hg and oxygen saturation is 88%. Which of the following is the most appropriate intervention?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Prescribe long-term supplemental oxygen for at least 15 hours per day

This patient has severe chronic resting hypoxemia, defined by a room-air PaO2 of 55 mm Hg or less or an oxygen saturation of 88% or less while clinically stable. Long-term oxygen therapy for at least 15 hours per day is recommended in this setting and improves survival. Oxygen only during exertion is considered for severe exertional desaturation when resting oxygenation does not meet long-term therapy criteria; it would undertreat this patient. A PaO2 below 40 mm Hg is not the treatment threshold. Chronic systemic prednisone has substantial toxicity without disease-modifying benefit in stable COPD. Theophylline does not slow COPD progression and has limited efficacy, important drug interactions, and a narrow therapeutic index.

Reference: Jacobs SS, et al. Home Oxygen Therapy for Adults with Chronic Lung Disease: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202:e121-e141. https://pubmed.ncbi.nlm.nih.gov/33185464/