Chapter 16: Asthma and Chronic Obstructive Pulmonary Disease Medications
1. A primary care nurse practitioner (NP) is evaluating a patient with asthma who reports having wheezing and coughing 1 or 2 days each week and awakening from sleep three or four times each month with asthma symptoms. The patient’s forced expiratory volume in 1 second (FEV1) is 80% of the predicted value. The patient’s current medication regimen is an albuterol metered-dose inhaler, 2 puffs every 4 hours as needed. The NP should prescribe:
montelukast (Singulair) po daily.
ipratropium bromide bid with albuterol.
a low-dose inhaled corticosteroid (ICS), 2 puffs bid.
a long-acting â-adrenergic agonist (LABA), 1 puff bid.
2. A primary care NP sees an adolescent patient for a hospitalization follow-up after an asthma exacerbation. The patient reports having daily symptoms with nighttime awakening 4 or 5 nights per week and misses school several days each month. The patient currently uses a salmeterol/fluticasone LABA twice daily and albuterol as needed. The patient requires a refill of the albuterol prescription once a month. The patient does not have any known allergies. The NP should:
order a high-dose ICS plus a LABA twice daily.
consider adding theophylline to this patient’s regimen.
continue the current regimen and add omalizumab daily.
order a combination product with ipratropium and albuterol.