A 55-year-old male, who has been smoking one pack of cigarettes per day for 25 years, presents with increasing shortness of breath over the last year. He notices the dyspnea especially when climbing stairs or doing light physical activities. He also reports a chronic cough that produces clear sputum, but denies chest pain or hemoptysis. He has no history of asthma, and this is the first time he has sought medical attention for his breathing problems. He has tried to quit smoking several times but has been unsuccessful. Physical Exam Findings: Respiratory rate: 20 breaths per minute Mild wheezing on auscultation, no use of accessory muscles Oxygen saturation: 96% on room air Initial Investigations: Spirometry results: Post-bronchodilator FEV1/FVC ratio of 65%, FEV1 is 80% of the predicted value Chest X-ray: Mild hyperinflation but no other abnormalities MCQs: What is the most likely diagnosis based on the spirometry results? A) Chronic bronchitis B) Mild COPD C) Asthma D) Pulmonary fibrosis What is the first-line treatment for this patient? A) Long-acting beta-agonist (LABA) and inhaled corticosteroid (ICS) B) Short-acting beta-agonist (SABA) as needed and smoking cessation C) Oral corticosteroids and antibiotics D) Oxygen therapy What is the most important step in long-term management for this patient? A) Spirometry every 6 months B) Smoking cessation support C) Annual influenza vaccination D) Pulmonary rehabilitation Answers with Explanations: Answer: B) Mild COPD Explanation: A post-bronchodilator FEV1/FVC ratio of less than 70% confirms airflow limitation. An FEV1 of 80% of the predicted value suggests mild COPD (GOLD stage 1). Answer: B) Short-acting beta-agonist (SABA) as needed and smoking cessation Explanation: For mild COPD, a SABA is prescribed for symptom relief, and smoking cessation is crucial for slowing disease progression. Answer: B) Smoking cessation support Explanation: Smoking cessation is the most effective intervention to prevent further lung function decline in COPD. Offering pharmacotherapy (nicotine replacement, varenicline) and counseling is critical. Overview of the Topic: Mild COPD COPD is staged based on spirometry, with mild disease classified by an FEV1 ≥ 80%. Management includes short-acting bronchodilators for symptom relief and smoking cessation support as the primary intervention to slow disease progression. Key Learning Points: Spirometry is essential for diagnosing and staging COPD. Smoking cessation is the most important intervention in COPD management. SABAs provide symptomatic relief in mild COPD.
