A 72-year-old woman with advanced COPD has severe refractory dyspnea despite optimized inhalers, pulmonary rehabilitation, and oxygen for resting

Question

A 72-year-old woman with advanced COPD has severe refractory dyspnea despite optimized inhalers, pulmonary rehabilitation, and oxygen for resting hypoxemia. She is not imminently dying and wants to remain alert. Which of the following is the most appropriate management?

Accepted Answer

Offer low-dose opioid therapy with careful titration and monitoring

Answer

Use benzodiazepines as the sole first-line dyspnea therapy

Answer

Escalate oxygen flow to normalize saturation above 99 percent

Answer

Avoid palliative care until mechanical ventilation is needed

Answer

Discontinue COPD-directed therapy and enroll in hospice immediately

Refractory dyspnea in advanced COPD — ABIM Board MCQ

A 72-year-old woman with advanced COPD has severe refractory dyspnea despite optimized inhalers, pulmonary rehabilitation, and oxygen for resting hypoxemia. She is not imminently dying and wants to remain alert. Which of the following is the most appropriate management?