Letta, age 78 presents for hospital follow up. She has been maintained on an inhaled corticosteroid, a long-acting beta agonist, a long-acting muscarinic agent and montelukast (Leukotriene inhibitor) for her chronic obstructive pulmonary disease (COPD) for the past 1 1/2 years. On chart review, you see that this was her second occurrence of pneumonia in the past 5 months. She also uses Combivent Respimat [combination albuterol (short-acting beta agonist) and ipatropium bromide (short-acting muscarinic agonist)] as a reliever medication as needed. An appropriate action(s) to consider would be: (Check all that apply) Increase the dose of her inhaled corticosteroid • Add daily low dose azithromycin (macrolide) for next year • Withdraw the Inhaled corticosteroid • Discontinue the Combivent Respimat (combination SABA and SAMA)
