Charlie Harness is a 61-year-old man, newly diagnosed this year with early COPD secondary to bouts of chronic bronchitis. Charlie had been a cigarette smoker since age 15 but proudly tells everyone...

Charlie Harness is a 61-year-old man, newly diagnosed this year with early COPD secondary to bouts of chronic bronchitis. Charlie had been a cigarette smoker since age 15 but proudly tells everyone that he “quit cold turkey 5 years ago and hasn’t touched one since!” He was surprised by the diagnosis of COPD even though he had been having increasingly long bouts of bronchitis and had noticed that he seemed more out of breath after each one. Charlie’s father died at age 52 “from some kind of lung problem,” which Charlie thinks might have been caused by smoking. Charlie still works as a service technician in the local tire and battery store and hopes to work until he is 70. His daughter just had a baby last year and he tells you, his nurse, “I want to be around to see my grandson graduate from high school!” Charlie has come to his health care provider today because of increasing shortness of breath. He relates this to allergy season” when he feels his bronchitis flare and with it, increasing dyspnoea. His physical exam reveals that Charlie is experiencing mild to moderate shortness of breath with him pausing for a breath after two or three sentences. His pulse is 108 beats/min, respiratory rate 28 breaths/min, blood pressure 150/80 mmHg, and he is afebrile. A pulse oximeter reading is 94% and you note that Charlie’s past readings have averaged between 94% and 97%. His breath sounds reveal a prolonged expiratory phase and are distant. He has inspiratory wheezing and he tells you that he frequently coughs up small amounts of beige-white mucus. He denies abdominal distention or tenderness. His provider gives him a prescription for an antibiotic and refill prescriptions for his bronchodilator and budesonide (Pulmicort) inhalers. Charlie is to return in 2 days for reassessment but tells you, “This should do the trick, it always does if I stay ahead of it.” In the evenings, Charlie spends much of his time on the Internet, video-chatting with his daughter and son-in-law, viewing photos of his grandson, and reading articles on various websites. He has recently discovered information about steroids and expresses some concern about the information he has read. He is considering not taking his budesonide inhaler anymore and asks you what he should do.

1. Create a list of questions you would ask Charlie to determine if he is experiencing any adverse effects from the corticosteroids.

2. What would you tell this patient related to abruptly discontinuing this medication? Why?

3. Charlie asks you if there are any precautions that he should take related to his budesonide (Pulmicort). How would you respond?