For COPD without evidence of infection on imaging or labs, which treatment is appropriate?

• A. Prednisone (oral)
• B. Inhaled bronchodilators
• C. Antibiotics
• D. Oxygen therapy

Answer: (B)

In stable COPD without infection, the main approach is to improve airway airflow with inhaled bronchodilators. These medications relax airway smooth muscle and widen the airways, which reduces dyspnea, improves exercise tolerance, and lowers the risk of symptoms on a daily basis. They can be used for quick relief (short-acting) or for ongoing maintenance (long-acting) to keep symptoms at bay.

Antibiotics are reserved for situations with signs of infection or during acute exacerbations, not for stable disease. Prednisone is also reserved for acute exacerbations or specific inflammatory phenotypes, not as routine therapy for stable COPD. Oxygen therapy is indicated only for patients with chronic resting hypoxemia, not all COPD patients.

So, without infection evidence, inhaled bronchodilators are the appropriate treatment choice.