American Board of Family Medicine (ABFM) Practice Exam

A patient with COPD is experiencing breathlessness despite using albuterol and a daily LABA. Which intervention can improve his breathing?

1. Replace inhaled medications with nebulized alternatives

2. Refer for outpatient pulmonary rehabilitation

3. Order home oxygen

4. Replace tiotropium with ipratropium

The correct answer is: Refer for outpatient pulmonary rehabilitation

The option of referring the patient for outpatient pulmonary rehabilitation is a valuable intervention for individuals with chronic obstructive pulmonary disease (COPD) who continue to experience breathlessness, even while using bronchodilators like albuterol and a long-acting beta agonist (LABA). Pulmonary rehabilitation is a comprehensive, evidence-based program that includes exercise training, disease education, and nutritional advice, which together can significantly enhance the patient's functional status and quality of life. Patients with COPD often face challenges not just due to respiratory symptoms but also related to deconditioning and a poor understanding of their disease management. Engaging in a structured pulmonary rehabilitation program can help the patient improve their exercise capacity, reduce symptoms of breathlessness, and increase overall pulmonary function over time. Additionally, these programs often educate patients about proper inhaler technique and the importance of medication adherence, which can further support improved outcomes. While other options might offer certain benefits, such as nebulization for patients who have difficulty with inhaler technique or the use of home oxygen for those with significant hypoxemia, those interventions may not address the underlying issues related to physical activity and overall lung health as effectively as referral for pulmonary rehabilitation. Therefore, outpatient pulmonary rehabilitation stands out as the most appropriate choice for improving this patient's