Ease Into Prep with a PANCE^® Question of the Day

The correct answer is A. This patient has resting hypoxia and therefore would benefit in terms of survival with the use of continuous, low-flow home oxygen therapy. Care must be taken as to not deliver high concentrations of oxygen, as that would suppress his respiratory drive. Oxygen saturation in these patients should be maintained just above 90%. Continuous home oxygen therapy in this patient will not only improve symptoms, but also prolong survival. Indications for home oxygen therapy are as follow:

• Arterial pO₂ (PaO₂) less than or equal to 55 mmHg, or an arterial oxygen saturation (SaO2) less than or equal to 88 percent.
• PaO2 less than or equal to 59 mmHg, or an SaO2 less than or equal to 89 percent, if there is evidence of cor pulmonale, right heart failure, or erythrocytosis (hematocrit >55 percent).

High-dose oral prednisone (choice B) may improve symptoms in the short-term during an acute exacerbation, but it has no role in the long-term management of patients with chronic obstructive pulmonary disease (COPD) and it does not prolong survival.

Choices C and D are appropriate measures to take in every COPD patient to prevent pneumococcal and influenza pneumonias respectively, but they do not provide the same prolongation of survival.

A tracheostomy (choice E) plays no role in the management of COPD, unless the patient is in an intensive care unit setting and cannot be weaned from a respirator.

PEARL: COPD patients with severe disease tend to have chronic hypoxemia and therefore long-term home oxygen therapy should be initiated as it improves survival and quality of life in these patients. The only other intervention that would decrease mortality is smoking cessation.

Remember the only 2 interventions that will improve survival in patients with COPD are: home oxygen therapy and smoking cessation .