Question

A client says to you, "My medications aren't working. I'm still short of breath even after using those puffers!" You review the client's chart and note the diagnosis of chronic obstructive pulmonary disease (COPD). The client is prescribed two inhalers, one a combination of fluticasone and salmeterol (Advair diskus) to be used twice daily and the other, albuterol (Ventolin) PRN for episodes of shortness of breath.

Concerning their medications, how will you go about investigating this complaint with your patient?

Answer 1

To address a COPD patient's complaint that their inhalers aren't working, investigate their medication adherence, ensure proper inhaler technique, assess for exacerbation of symptoms, consider alternative causes or worsening of their disease, and discuss the progression of COPD and lifestyle factors.

Step-by-step explanation:

Investigating the Complaint of Ineffective Medications in a COPD Patient

If a client with chronic obstructive pulmonary disease (COPD) reports that their inhalation therapies are ineffective, it is important to assess their method of medication use, adherence to the prescribed regimen, and to review any possible changes in symptoms or disease status. For the medications mentioned, fluticasone and salmeterol (Advair Diskus) and albuterol (Ventolin), it's crucial to ensure that the client is using the inhalers correctly, as improper technique can lead to reduced efficacy of the medication. It's also essential to ascertain if the client is using the maintenance inhaler (Advair Diskus) twice daily as prescribed, and the rescue inhaler (Ventolin) as needed, without exceeding the recommended frequency.

After confirming adherence to the regimen and proper inhalation technique, evaluate the client's symptoms. Has there been any recent exacerbation of shortness of breath, or a change in cough or sputum production? It may be necessary to consider other causes, such as a pneumonia or a worsening of COPD, which might require different or additional treatments such as antibiotics, systemic corticosteroids, or increased use of bronchodilators. Monitoring for potential side effects of the medications and discussing the progression of COPD with the patient are also important aspects of the assessment.

In some cases, referral to a pulmonologist or consideration of other modalities such as pulmonary rehabilitation or supplemental oxygen may be warranted. Additionally, addressing any lifestyle factors, such as smoking cessation if the patient is a smoker, can have a significant impact on disease progression and symptom management in COPD.