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 β2-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 exacerbation takes longer than it used to—it is often 2 weeks before he is able to get back to work—and 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 ½ pack per day for 40 years.
His last pulmonary function tests 6 months ago showed an FEV1 that was 52% of predicted.
Case Study Questions
Based on this information, what are your treatment goals for this patient?