Review Question - QID 105857

This patient is presenting with a significant smoking history, fever, diffuse wheezing, and respiratory distress which is concerning for a COPD flare secondary to pneumonia. Ipratropium (a muscarinic receptor antagonist) is an appropriate initial measure.

COPD typically results from long-term cigarette smoking and is characterized by decreased expiratory flow rates and increasing lung volumes as the disease progresses. The only therapeutic interventions that prolong survival in COPD are smoking cessation, supplemental oxygen, and vaccinations. The treatment of a COPD flare involves administration of albuterol, ipratropium, steroids, antibiotics (if there is a suspected pneumonia), BiPAP, and intubation if necessary.

Incorrect Answers:
Answer 1: Alpha-1 blockers such as phentolamine can be used to reduce blood pressure; however, they have no indication in the management of a COPD flare.

Answer 2: Alpha-2 blocker such as yohimbine are not typically used and do not have an indication in treating COPD.

Answer 3: Beta-2 blockers such as metoprolol are indicated for ischemic heart disease or atrial fibrillation; however, it could be contraindicated in acute asthma/COPD as these drugs could cause bronchospasm (think of how this antagonizes the effect of albuterol).

Answer 4: Glucocorticoid-analogue or steroids are indicated in an acute COPD flare but take hours to take effect.

Bullet Summary:
The treatment of a COPD flare involves administration of bronchodilators including albuterol (a beta-2 agonist) and ipratropium (a muscarinic antagonist).