A 69-year-old man with newly diagnosed COPD smokes 25 cigarettes per day. Which is the most appropriate initial management option?

• A. Inhaled corticosteroids and long-acting beta-agonist therapy
• B. Antibiotics course for COPD exacerbation
• C. Smoking cessation advice and referral to local support group
• D. Oxygen therapy at rest

Answer: (C)

The crucial idea here is that quitting smoking is the most impactful step in managing COPD. Smoking is the primary driver of disease progression, symptoms, and exacerbations, so addressing it right away offers the best chance to slow decline in lung function and improve outcomes. Providing smoking cessation advice along with a referral to a local support group (and offering appropriate cessation aids like nicotine replacement or other pharmacotherapies) gives the patient the strongest path to quitting. The other options focus on treating symptoms during an exacerbation, using therapies that are not indicated until relaxation of the smoking factor or specific conditions are present (such as hypoxemia requiring oxygen), and thus do not address the root issue first. After cessation is underway, you’d then plan further COPD management and assessment, including spirometry-based staging and consideration of maintenance inhaler therapy.