2 Days Of Worsening in Medicine / Internal Medicine — 68yo Man | Respiratory / Pulmonology | SMLE Q#11058
SMLE Question #11058
Medicine / Internal Medicine
Respiratory / Pulmonology
Objective: OBJ-123
Last updated: February 2026
A 68-year-old man with COPD (40-pack-year smoking history) presents with 2 days of worsening dyspnea, increased cough, and purulent sputum. He uses tiotropium and salmeterol at home. Examination shows diffuse wheezes and prolonged expiration, without focal crackles. After starting controlled oxygen and nebulized short-acting bronchodilators (salbutamol–ipratropium), what is the most appropriate additional medication as part of initial emergency management?
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