10th September 2020

A 75-year-old, morbidly obese patient with a 20-year history of bronchitis-predominant COPD presents to the respiratory clinic

A 75-year-old, morbidly obese patient with a 20-year history of bronchitis-predominant COPD presents to the respiratory clinic for a review of her condition. She is currently on triple therapy (LABA, LAMA and ICS), however, has had 2 hospitalisations in the last 2 months due to exacerbations. She says she is struggling to cope at home as she lives alone and finds she is very breathless when she has to leave the house to walk to the local shop at the end of her road. She has no other comorbidities. Her arterial blood gas reveals a PaO₂ of 7.5kPa and spirometry shows an FEV₁ that is 45% of predicted.

For the patient above, please select the SINGLE most appropriate intervention for their COPD. Select ONE option from the list above.