| May 19, 2015

1. Read the attached case study
2. write a 2 pages paper with this 6 components all addressed in relations to the case study:

A. Identification of global initiative for COPD or GOLD
B. Pharmacological approach you would take and rationale
C. Non pharmacological approach
D. Activity/ exersise
E Patient teaching
F Follow up ( labs, consults, etc)


Karla, a 53 y/o nurse comes to your office c/c wheezing and chest tightness for 4 days. Was seen in your office 2 weeks ago for Bronchitis. She was prescribed then, a burst of Prednisone, a course of Azithromycin and Tessalon perles for her cough. She gave herself a albuterol neb tx prior to coming. “I had a hard time breathing last night and was up all night”

Smoking hx, 1/2 ppd for 30 years. Weaned herself off of Symbicort (because she denies she has COPD) and “don’t want to be dependent of the medication”

No know allergies. Meds: Albuterol inhaler and neb. She was told she might have COPD but was supposed to go for testing but refused to go.


T98.2, P92, R24, BP 128/80, SPO2 94%, wt. 145lbs, ht. 5’4″

HEENT: normal

Lungs: wheezing and diminished/tight lung sounds

CV: normal rate and rhythm, no murmur, no CP, EKG done – NSR. No Edema

Psych/Neuro: slightly apprehensive, Cranial nerves intact, no deficits

Differentia Dx: Bronchitis, Asthma, URI, COPD

Final Dx: COPD

What’s your plan of care? (Identify Global Initiative for COPD or GOLD standard).


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State Government Professional Services Agency Australia (PSAA)
Industry Report/ supermarkets in the UK


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