Hi rick5547 Thanks for coming to HCM COPD needs staging via spirometry and accordingly treatment has to be given. the treatment also depends on whether the patient has got respiratory failure, is she in acute exacerbation, has she got any comorbidities like heart disease, diabetes, osteoporosis, depression etc... You can try a combination of long acting beta 2 agonists like salmeterol or formoterol plus inhaled corticosteroid like budesonide or fluticasone along with long acting muscarinic antagonists like tiotropium... If your wife is in acute exacerbation manifested by increased baseline dyspnoea, cough, sputum production and its purulency...you can give her a course of antibiotivs like amoxycillin clavulanic acid and azithromycin alon with short course of steroids like prednisolone 40 mg once a day for 10-14 days....and don t forget the nebulisation by salbutamol and ipratropium 6 hrly... If she is continoussly in respiratory failure then probably she is needing controlled oxygen therapy to maintain oxygen saturation just above 90%.... best wishes