A 57-year-old self-employed contractor makes an appointment for another “chest infection.” He caught an upper respiratory tract infection from his grandchildren 10 days ago, and he now has a productive cough with green sputum, and his breathlessness and fatigue has forced him to take time off work.
As a nurse practitioner in a primary care practice, you have seen him with similar symptoms two or three times every year for the last several years. A diagnosis of COPD was confirmed 6 years ago, and he was started on a short-acting 2-agonist. This helped with his day-to-day symptoms, although recently the symptoms of breathlessness have been interfering with his work and he has to pace himself to get through the day. Recovering from exacerbations takes longer than it used toit is often 2 weeks before he is able to get back to workand he feels bad about letting down customers. He cannot afford to retire, but is thinking about reducing his workload.
He quit smoking once for a short time, but has otherwise smoked 1 packs per day for 40 years. His last pulmonary function tests 6 months ago showed an FEV1 that was 52% of predicted.
Case Study Questions
What medication would you prescribe for him?
What patient teaching would you provide for him?
