For the scenarios below, Answer the questions below using clinical practice guideline where applicable. Explain the problem and explain how you would address the problem. If prescribing a new drug, write out a complete medication order just as you would if you were completing a prescription. Use at least 3 sources for each scenario and cite sources using APA format.
Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?
Title: Management of Chronic Shortness of Breath in a Patient with Chronic Bronchitis
Introduction
Daute, a 56-year-old man with a history of chronic bronchitis and increasing shortness of breath, presents a challenging case that requires a comprehensive treatment plan. The primary goal is to improve his respiratory symptoms, enhance his quality of life, and prevent exacerbations. Addressing his non-adherence to prescribed medications and smoking history is crucial for effective management.
Treatment Plan
To address Daute's chronic shortness of breath and chronic bronchitis, the following treatment plan can be implemented:
1. Prescription Medication:
- Initiate treatment with tiotropium (Spiriva) inhalation capsule 18 mcg once daily for maintenance therapy.
- Consider adding albuterol (ProAir HFA) inhaler as a rescue medication for acute symptom relief.
2. Smoking Cessation Support:
- Refer Daute to smoking cessation programs or resources to help him quit smoking.
3. Lifestyle Recommendations:
- Encourage regular physical activity within Daute's tolerance level to improve overall lung function.
- Advise proper inhaler technique and adherence to medication regimen.
Monitoring Effectiveness
To monitor the effectiveness of the treatment plan:
- Assess Daute's symptom improvement through regular follow-up visits and spirometry tests.
- Evaluate his adherence to the prescribed medications and provide education on their importance.
- Monitor any exacerbations of chronic bronchitis and adjust treatment as necessary.
Medication Prescription:
1. Tiotropium (Spiriva) inhalation capsule 18 mcg once daily
- Dispense #30 capsules
- Sig: Inhale the contents of one capsule once daily using the HandiHaler device.
2. Albuterol (ProAir HFA) inhaler
- Dispense #1 inhaler
- Sig: Inhale 2 puffs as needed for shortness of breath
Conclusion
In conclusion,
managing chronic shortness of breath in a patient like Daute with chronic bronchitis involves a combination of pharmacological therapy, lifestyle modifications, and patient education. By addressing his symptoms with appropriate medications, supporting smoking cessation efforts, and monitoring his progress closely, healthcare providers can improve Daute's respiratory function and quality of life.
References:
1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2021). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. [Link](insert link)
2. American Thoracic Society. (2020). Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 203(10), e31-e69. [Link](insert link)
3. National Institute for Health and Care Excellence (NICE). (2019). Chronic Obstructive Pulmonary Disease in Over 16s: Diagnosis and Management. [Link](insert link)