COPD — Emphysema and Chronic Bronchitis

A 58-year-old man with a 40 pack-year smoking history presents with progressive dyspnea, chronic productive cough, and recurrent respiratory tract infections. Spirometry shows FEV₁ 35% predicted with poor bronchodilator response. He is already on inhaled corticosteroids and long-acting beta-2 agonists. What is the drug of choice to reduce exacerbation frequency and mortality in this patient?

A 58-year-old man with known COPD (FEV₁ 35% predicted) presents with acute worsening of dyspnea, increased sputum purulence, and fever over 3 days. Chest X-ray shows no new infiltrates. To identify the causative organism and guide antibiotic therapy, which investigation is most appropriate?

A 62-year-old male smoker with a 40 pack-year history presents with progressive dyspnea and chronic productive cough. Spirometry shows FEV₁/FVC ratio of 0.65 with reduced DLCO. High-resolution CT chest reveals destruction of alveolar walls with loss of elastic recoil. Which is the most common site of emphysematous destruction in this patient?

A 58-year-old woman with a 35-pack-year smoking history presents with progressive dyspnea at rest and minimal cough. On examination, she has a barrel chest, pursed-lip breathing, and diminished breath sounds bilaterally. Spirometry shows FEV₁ 28% of predicted with an FEV₁/FVC ratio of 0.42. High-resolution CT chest demonstrates extensive centrilobular and panlobular lucencies predominantly in the upper lobes and apices, with minimal bronchial wall thickening. Which pathological mechanism best explains the reduction in FEV₁ in this patient?

A 65-year-old man with chronic productive cough and recurrent respiratory infections is diagnosed with chronic bronchitis. Compared to a colleague's patient with emphysema who has minimal sputum production and dyspnea on exertion, which pathological feature most reliably distinguishes chronic bronchitis in this case?