A 67-year-old patient with a history of COPD presents to the emergency department with increased shortness of breath, wheezing, and a productive cough with green sputum. The patient has a respiratory rate of 26 breaths/min, oxygen saturation of 88% on room air, and is using accessory muscles to breathe. After administering supplemental oxygen, what is the next best step in the management of this patient?
Initiate systemic corticosteroid therapy.
Order an immediate chest x-ray.
Prescribe antibiotic therapy for suspected bacterial infection.
Administer a short-acting bronchodilator via nebulizer.
Administering bronchodilators is the next best step after providing supplemental oxygen in a COPD exacerbation. Bronchodilators help open up the airways and reduce wheezing, improving ventilation. Systemic corticosteroids are often used but not before bronchodilators. Antibiotic therapy may be indicated for potential bacterial infection due to the green sputum, but the immediate concern is bronchodilation. A chest x-ray is important for diagnosis but not as immediate as bronchodilator therapy in the management of exacerbation symptoms.
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