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Original Question
Janis, a 59 year old female, here for yearly follow-up and refills on her medications and to review labs and diagnostics. She presents with complains of increasing shortness of breath. She has an 20 pack year history of smoking. She has decreased her number of cigarettes to 10 per day. The shortness of breath began a few months ago but seems to be worsening with activity. She is only able to walk around the block without shortness of breath. She also is no longer able to walk 18 holes when playing golf. Past Medical History: Janis has COPD. In the past year, she has had 1 exacerbation of her COPD and no hospitalizations. She has attempted to stop smoking, using nicotine gum replacement unsuccessfully. She has decreased the number to 10 cigarettes per day and would like to quit. She has osteoarthritis in the hands and knees. She has HTN well controlled with Olmesartan. Hyperlipidemia, well controlled with Rosuvastatin. She has not had most recent COVID vaccination. She has had Shingrix vaccine. She has not had flu shot this year and she has not had pneumonia vaccine. Surgical History ■Cholecystectomy ■appendectomy Family History: Noncontributory. Social History: She lives with her husband who also smokes 1 packs of cigarettes per day and cares for her elderly mother, who lives with them and is frail but ambulatory. Medications: • Salmeterol 50 mcg per actuation DPI 1 inhalation every 12 hours • albuterol 90 mcg per actuation MDI as needed • Naproxen 500 mg by mouth twice daily as needed for arthritic pain. • Olmesarton 20 mg daily • Rosuvastatin 10 mg daily WHAT MEDICATION DO I ADD
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