MRCP2-4170

MRCP2-4170

A 65-year-old man presents to his primary care physician three weeks after experiencing an infective exacerbation of COPD. He is currently feeling well but is worried that this is his second exacerbation this winter. He is currently taking fostair, tiotropium, and salbutamol as needed. He has a mild cough but has attended his recent COPD review.

Upon examination, his chest is clear with no wheezing or crepitations. His JVP is not raised, and there is no edema. His oxygen saturation is 94% in air, and he has a respiratory rate of 22 breaths per minute. He is currently able to do his gardening and walk his dog up to half a mile each day without experiencing breathlessness at night. He has been discharged from chest physio and is performing well.

FEV1 (% predicted) is 40%, and FVC (% predicted) is 80%. A chest x-ray reveals several bullae and a hyperexpanded chest with no consolidation. An ECG shows sinus rhythm and a right bundle branch block.

What additional intervention should be considered for this patient’s current management?