In COPD patient with persistent symptoms on albuterol, which addition is most appropriate for group B?

• A. Inhaled ipratropium
• B. Inhaled tiotropium
• C. Oral prednisone
• D. Oral theophylline

Answer: (B)

Persistent symptoms in COPD despite using a short-acting bronchodilator point to the need for a maintenance, long-acting bronchodilator. For a patient in Group B, who has substantial symptoms but a low risk of exacerbations, the goal is to improve daily symptoms and function with sustained bronchodilation. Tiotropium is a long-acting muscarinic antagonist inhaled daily, providing ongoing airway bronchodilation, improving dyspnea and exercise tolerance, and reducing future exacerbations compared with relying on short-acting relief alone. That makes inhaled tiotropium the best addition.

Inhaled ipratropium is a short-acting anticholinergic and doesn’t offer sustained control for daily symptoms. Oral prednisone isn’t appropriate for stable COPD due to systemic side effects and lack of long-term benefit in this setting. Theophylline is an older agent with a narrow therapeutic window and more adverse effects, not preferred as first-line add-on therapy.