A 60 years old male presents to your clinic today with complaints of productive cough and shortness of breath for 2 weeks. The patient has smoked at least one pack of cigarettes a day for the last 45 years. He denies fever or chest pain except with cough. He has been using his albuterol inhaler at least 6 times a day. His past medical history includes hypertension (HTN) and chronic obstructive pulmonary disease (COPD). The patient’s current medications are albuterol HFA, atenolol XL 50mg q hs. Vital signs are BP 126/80, R 20, HR 80, SpO2 91% on RA. Physical examination shows that the patient is awake, alert and oriented to person, time and place. Lungs are coarse to auscultation throughout, wheezes are present, and patient coughs with deep inspiration, mildly retracting.

1. What additional history would you like for this patient?

2. What are your treatment goals for this patient?

3. If you plan to start drug treatment today:

a. What is your choice, and dose, and for how long?

b. What is your rationale for this choice?

4. Are there any major drug-to-drug interactions, side effects or adverse reactions to this drug?

5. What patient education regarding the use of this drug and the plan of care would you give?