Copd (fev1 32% Predicted) in Medicine / Internal Medicine — 65yo Man | Respiratory / Pulmonology | SMLE Q#11991
SMLE Question #11991
Medicine / Internal Medicine
Respiratory / Pulmonology
Objective: OBJ-123
Last updated: February 2026
A 65-year-old man with COPD (FEV1 32% predicted) and a 60-pack-year smoking history has 4 months of worsening exertional dyspnea; he is now limited to one block. He uses umeclidinium/vilanterol daily and salbutamol as needed, with rare exacerbations. Exam shows a thin, barrel-chested man with diffusely decreased breath sounds and prolonged expiration. CT chest shows upper-lobe–predominant emphysema. PFTs show severe obstruction with hyperinflation and low diffusing capacity. What intervention is most likely to provide the greatest improvement in chronic dyspnea?
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