Question

Case Study 5-3

A patient with COPD

patient with COPD Is currently taking albuterol by MDI four times a day. The patient states that her inhaler does not seem to work as well as it used to. She still gets short of breath and it is sometimes hard to wait for the next dose. She is not taking any other medications at this time. Which of the following would you recommend?

(a) Continue albuterol as ordered.

(b) Give albuterol by nebulizer.

(c) Discontinue albuterol and give Serevent®.

(d) Continue albuterol and add tiotropium once a day.

Explain your answer.
The physician asks if you think the patient would do better with levalbuterol (Xopenex®). What do you think?
If levalbuterol is ordered, should another drug be used with it? Why or why not?

Answer 1

Ans : Continue Albuterol and add Tiotropium .

Patient already taking Albuterol by MDI four times a day and complaints of shortness of breath can added to Tiotropium once daily with the reasonable expectation of atleast equalent bronchodilation during day time hours and superior bronchodilation during early morning hours.

I didn't think the patient better with Levalbuterol . Because Levalbuterol is also a short acting bronchodilatior like Albuterol . Our Patient complaints shortness of breath while taking the short acting bronchodilatiors. So Levalbuterol also produce same effect to the patient.

If additional adrenergic drugs are are to be administered by any route with Levalbuterol , they should be used with caution to avoid deleterious cardiovascular effects. Inhalation solution is not a substitute for corticosteroid.

You should not use the Levalbuterol if you are allergic to Levalbuterol or Albuterol. Using Albuterol togather with Levalbuterol may increase cardiovascular side effects, such as elevation in heart rate and blood pressure or irregular heart rhythm.

Thankyou