Chief Complaint: “Why can’t I just take prednisone every day? It always works when I get admitted to the hospital.” HPI: Thomas Jones is a 66-year-old man with COPD presenting to the family medicine clinic today for a 1-month followup appointment from his last hospital admission for an acute exacerbation of COPD. This last COPD exacerbation is the second hospital admission in the last 6 months related to TJ’s COPD instability. After TJ’s hospitalization, his discharge COPD regimen was changed to include tiotropium, 1 inhalation daily in addition to salmeterol 50 mcg, 1 inhalation Q 12h, and an albuterol MDI as needed. TJ had pulmonary function tests (PFTs) while he was in the hospital 1 month ago but has yet to have them reassessed after the change in his COPD regimen. He wants t
Subjective
Chief Complaint: “Why can’t I just take prednisone every day? It always works when I get admitted to the hospital.”
HPI: Thomas Jones is a 66-year-old man with COPD presenting to the family medicine clinic today for a 1-month followup appointment from his last hospital admission for an acute exacerbation of COPD. This last COPD exacerbation is the second hospital admission in the last 6 months related to TJ’s COPD instability. After TJ’s hospitalization, his discharge COPD regimen was changed to include tiotropium, 1 inhalation daily in addition to salmeterol 50 mcg, 1 inhalation Q 12h, and an albuterol MDI as needed. TJ had pulmonary function tests (PFTs) while he was in the hospital 1 month ago but has yet to have them reassessed after the change in his COPD regimen. He wants to start taking prednisone every day because he believes this would prevent him from being readmitted to the hospital. The patient states that his respiratory symptoms are better than when he was admitted 1 month ago, but he still has shortness of breath every day and a decreased exercise capacity (e.g., he becomes very short of breath after walking a couple of blocks). He states that he is adherent to the new medication regimen that was changed on discharge from the hospital. No other medications were changed at that time that he can recall. His daughter, who is at the appointment today, states that she makes sure he uses his inhalers but often wonders if he is using them correctly because he still has daily symptoms.
PMH: COPD × 12 years, GERD × 5 years, HTN × 20 years, CAD (MI 5 years ago)
FH: Mother died from emphysema 4 years ago at the age of 82. Father has a history of coronary artery disease.
SH: He lives with his daughter and her family. His wife died 10 years ago from breast cancer. He has a 35-pack-year history of smoking. He quit smoking approximately 3 months ago but has had occasional relapses. He states he has not smoked for approximately a week. He drinks one to two beers every evening.
Meds: Metoprolol tartrate 50 mg PO BID, Salmeterol (Serevent Diskus) 1 inhalation (50 mcg) BID, Tiotropium (Spiriva) 1 capsule (18 mcg) inhaled once daily, Lisinopril 20 mg PO once daily, Esomeprazole (Nexium) 20 mg PO once daily, Albuterol MDI 1–2 puffs Q 6 h PRN, Aspirin 81 mg PO once daily
ROS: (+) Shortness of breath with chronic nonproductive cough; (+) fatigue; (+) exercise intolerance
Kindley answer case study Patient therapeutic care plan. TYSM
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What feasible pharmacotherapeutic alternatives are available for
the treatment of COPD in this patient based on his response to
the current medication regimen and the most recent GOLD
guideline recommendations?
2. Should home oxygen therapy be considered for the patient at this
time?
3. Is this patient a candidate for α1-antitrypsin (Prolastin) therapy
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