I often care for individuals with moderate-to-severe chronic obstructive pulmonary disease (COPD). These patients report that they follow the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines but insist that they continue to have difficulty breathing.

Typically, the oxygen saturation levels by pulse oximetry in these individuals are in the high 90s, and the patients report no improvement with an albuterol nebulizer. These patients are almost always smokers who have had pulmonary consults. What therapeutic option do you advise?— Cynthia Smith, FNP, South Charleston, W. Va.

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Is pulmonary rehabilitation included in the patients’ recommended regimen? If not, consider referral for this treatment. Also, many COPD patients become very anxious because of their constant subjective shortness of breath and benefit greatly from low doses of such anxiolytics as benzodiazepines. Once these patients relax, the feeling of air hunger dissipates. — Sherril Sego, FNP-C, DNP (182-6)

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