SubjectiveChief 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 dailyROS: (+) Shortness of breath with chronic nonproductive cough; (+) fatigue; (+) exercise intolerance Kindley answer case study Patient therapeutic care plan. TYSM A. CASE ANALYSIS:Prepare a patient therapeutic care plan.Patient Name: Thomas JonesAddress: n/aMedical Condition:Tobacco/Alcohol/Substance Use:Allergies:Drug NameMedical ConditionPATIENT THERAPEUTIC CARE PLAN RECORDGender: MaleAge: 66Birthdate: n/aRace: n/aWeight:Height:IndicationMEDICATION RECORDStrengthRegimenASSESSMENT, PLAN AND FOLLOW-UP EVALUATIONDrug-Therapy Problem Goal, Current Status andInterventionsAdverse DrugReactionsFollow-up Plan ObjectivePHYSICAL EXAMINATIONGen: WDWN man appearing in mild respiratory distress after walking to the end of the hall to reach the examroomVS: BP 138/88, P 85, RR 26, T 37.5°C; Wt 95 kg, Ht 5'11"Skin: Warm, dry; no rashesHEENT: Normocephalic; PERRLA, EOMI; normal sclerae; mucous membranes are moist; TMs intact;oropharynx clearNeck/Lymph Nodes: Supple without lymphadenopathy......Lungs: Tachypnea with prolonged expiration; decreased breath sounds; no rales, rhonchi, or cracklesCV: RRR without murmur; normal S1 and S2Abd: Soft, NT/ND; (+) bowel sounds; no organomegalyGenit/Rect: No back or flank tenderness; normal male genitaliaMS/Ext: No clubbing, cyanosis, or edema; pulses 2+ throughoutNeuro: A & O x 3; CN II-XII intact; DTR 2+; normal mood and affectLABORATORY EXAMINATIONNa 135 mEq/LK 4.2 mEq/LCl 108 mEq/LCO₂ 26 mEq/LBUN 19 mg/dLSCr 1.1 mg/dLGlu 109 mg/dLHgb 12.1 g/dLHct 38.5%Plt 195 x 10³/mm³WBC 6.4 x 10³/mm³AST 40 IU/LALT 19 IU/LT. bili 1.1 mg/dLAlb 3.1 g/dLPulse Ox 93% (RA)Pulmonary Function Tests (during Hospital Admission 1 Month Ago):Prebronchodilator FEV1 = 1.1 L (predicted is 3.1 L)Prebronchodilator FVC = 3.2 LPostbronchodilator FEV1 = 1.6 LPulmonary Function Tests (during Clinic Visit Today):Prebronchodilator FEV1 = 1.3 L (predicted is 3.1 L)Prebronchodilator FVC = 3.2 L• Postbronchodilator FEV1 = 1.47 LCa 8.9 mg/LMg 3.6 mg/LPhos 2.9 mg/dL

Question

SubjectiveChief 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 dailyROS: (+) Shortness of breath with chronic nonproductive cough; (+) fatigue; (+) exercise intolerance  Kindley answer case study Patient therapeutic care plan. TYSM A. CASE ANALYSIS:Prepare a patient therapeutic care plan.Patient Name: Thomas JonesAddress: n/aMedical Condition:Tobacco/Alcohol/Substance Use:Allergies:Drug NameMedical ConditionPATIENT THERAPEUTIC CARE PLAN RECORDGender: MaleAge: 66Birthdate: n/aRace: n/aWeight:Height:IndicationMEDICATION RECORDStrengthRegimenASSESSMENT, PLAN AND FOLLOW-UP EVALUATIONDrug-Therapy Problem Goal, Current Status andInterventionsAdverse DrugReactionsFollow-up Plan ObjectivePHYSICAL EXAMINATIONGen: WDWN man appearing in mild respiratory distress after walking to the end of the hall to reach the examroomVS: BP 138/88, P 85, RR 26, T 37.5°C; Wt 95 kg, Ht 5'11&#34;Skin: Warm, dry; no rashesHEENT: Normocephalic; PERRLA, EOMI; normal sclerae; mucous membranes are moist; TMs intact;oropharynx clearNeck/Lymph Nodes: Supple without lymphadenopathy......Lungs: Tachypnea with prolonged expiration; decreased breath sounds; no rales, rhonchi, or cracklesCV: RRR without murmur; normal S1 and S2Abd: Soft, NT/ND; (+) bowel sounds; no organomegalyGenit/Rect: No back or flank tenderness; normal male genitaliaMS/Ext: No clubbing, cyanosis, or edema; pulses 2+ throughoutNeuro: A & O x 3; CN II-XII intact; DTR 2+; normal mood and affectLABORATORY EXAMINATIONNa 135 mEq/LK 4.2 mEq/LCl 108 mEq/LCO₂ 26 mEq/LBUN 19 mg/dLSCr 1.1 mg/dLGlu 109 mg/dLHgb 12.1 g/dLHct 38.5%Plt 195 x 10³/mm³WBC 6.4 x 10³/mm³AST 40 IU/LALT 19 IU/LT. bili 1.1 mg/dLAlb 3.1 g/dLPulse Ox 93% (RA)Pulmonary Function Tests (during Hospital Admission 1 Month Ago):Prebronchodilator FEV1 = 1.1 L (predicted is 3.1 L)Prebronchodilator FVC = 3.2 LPostbronchodilator FEV1 = 1.6 LPulmonary Function Tests (during Clinic Visit Today):Prebronchodilator FEV1 = 1.3 L (predicted is 3.1 L)Prebronchodilator FVC = 3.2 L• Postbronchodilator FEV1 = 1.47 LCa 8.9 mg/LMg 3.6 mg/LPhos 2.9 mg/dL

Accepted Answer

COPD: 
The progressive lung condition known as chronic obstructive pulmonary disease (COPD) is…