R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic.

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk. He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%.

In a paper not to exceed six pages, excluding title and reference pages, please answer the following:

What is R. W.’s likely diagnosis?
What stage of disease does RW have?
List specific pharmacotherapeutic treatment goals for R. W.
What drug therapy would the CNP likely prescribe? Why?
What are the parameters for monitoring the success of the therapy?
Describe specific patient education based on the prescribed therapy.
List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.
What would be the choice for second-line therapy?
What health promotion activities should be recommended for this patient?
If RW was currently taking metoprolol for “headaches” would a change be recommended?

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