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COPD exacerbation — RACGP Fellowship MCQ

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HardChronic disease managementCOPD exacerbationRACGP Fellowship

A 58‑year‑old woman with COPD presents with increased dyspnoea, sputum volume and purulence for three days. Temperature is 37.8 °C, respiratory rate 24/min, oxygen saturation 91% on room air, and she can speak full sentences. She uses tiotropium and salbutamol. What is the most appropriate management?

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Correct answer: E — Treat as COPD exacerbation with bronchodilator optimisation, oral corticosteroid and antibiotic, and arrange close review

Explanation lettering: C = shown as B · B = shown as C

This patient is experiencing a moderate COPD exacerbation, evidenced by increased dyspnoea plus sputum volume and purulence. Australian best practice (Therapeutic Guidelines and COPD‑X) supports: optimisation of bronchodilators, systemic (oral) corticosteroids, and antibiotics when infection is likely, followed by close follow‑up. Option E encapsulates this multi‑pronged, evidence‑based approach. Options A and D delay effective treatment. Option B is unsafe—oxygen must be titrated, not given high‑flow blindly. Option C ignores the purulent sputum signifying bacterial involvement.

Reference: Australian Prescriber: "Managing chronic obstructive pulmonary disease – Australian Prescriber" (TG), COPD‑X Australian guidelines 2022 update