A 67-year-old man presents with progressive dyspnea. He has smoked cigarettes since he was 15 years of age. Worsening breathlessness forced him to retire as a laborer. His physical examination is notable for distant breath sounds on auscultation, with a prolonged expiratory phase. Spirometry reveals severe airflow obstruction (ratio of forced expiratory volume in first second [FEV1] to forced vital capacity, 0.43; FEV1, 34% of the predicted value). How should this case be managed?
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Dennis E. Niewoehner (2010) studied this question.
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