A 58-year-old man with COPD (post-BD FEV1/FVC 0.58, FEV1 42% predicted, frequent exacerbations) has dyspnea at rest and hypoxia (SpO2 87% at rest). He is on triple inhaler therapy (LABA+LAMA+ICS). CXR shows hyperinflation. Spirometry post-bronchodilator FEV1 improves by 180 mL. Which additional intervention has been shown to reduce mortality in this patient?
- A Roflumilast (PDE-4 inhibitor)
- B Long-term oxygen therapy (LTOT) for >15 hours/day ✓
- C Azithromycin prophylaxis
- D N-acetylcysteine nebulization
Correct answer: B. Long-term oxygen therapy (LTOT) for >15 hours/day
Explanation
Long-term oxygen therapy for >15 hours per day is one of the few interventions proven to reduce mortality in COPD, indicated when resting SpO2 ≤88% or PaO2 ≤55 mmHg, or PaO2 56–59 mmHg with cor pulmonale or secondary polycythemia. This patient's resting SpO2 of 87% meets criteria. The landmark MRC and NOTT trials established this mortality benefit. Roflumilast reduces exacerbations but has no proven mortality benefit. Azithromycin reduces exacerbations but not mortality.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.