The most significant adverse effects of tiotropium are dry mouth, sinusitis, cough, and headaches. Since is it is an anticholinergic, another significant adverse effect that can cause a change in therapy is that of tachyarrhythmias (Delgado & Bajaj, 2020). In the systemic circulation, it has the potential of causing narrow-angle glaucoma and urinary retention which can lead to permanent damage of vision and dysuria.Analysing factors associated with successful treatment.
The choice for Second-Line Therapy
A preferred second-line drug for RW would be a LABA such as formoterol 12DPI 12 μg 12 hourly. LABA has been demonstrated to decrease the need for rescue drugs, improve patient-associated outcomes and symptoms (Patel et al., 2019). Besides, they also have a good safety profile. Formoterol is a good choice in this case since it has a faster onset of action when compared to salmeterol.
Recommended Health Promotion Activities
The most appropriate health promotion activities for RW are education, ensuring up to date immunization, smoking cessation, and dietary medication to promote weight gain. RW should ensure that he gets annual pneumococcal and influenza vaccination. Evidence suggests that the aforementioned immunizations decrease pneumococcal and influenza-associated exacerbations in patients with COPD. He should also enroll in a smoking cessation program. The study by Ambrosino & Bertella (2018) reveals that smoking cessation decreases COPD-related morbidity, mortality and improves overall outcomes. With regards to dietary modification, the CNP should liaise with the dietician to improve his nutrition supplementation for increased muscle mass and weight gain. His diet should be rich in fruits, and vegetables.Analysing factors associated with successful treatment.
Recommended Change of Pharmacotherapy with Metoprolol
Metoprolol is a cardioselective beta-blocker that has demonstrated greater efficacy in managing patients with cardiovascular disease. Traditionally, the use of such agents in patients with COPD was contraindicated due to anecdotal evidence that it caused acute bronchospasms and increased hyperresponsiveness of the airways which is a major issue since that increases mortality in patients with COPD (Lipworth et al., 2016). However, the latest evidence reveals that COPD patients taking beta-blockers and a beta-agonist are less likely to experience exacerbations due to the cardio selectivity of beta-blockers. Therefore, as long as the dose of metoprolol for RW would be administered in doses that maintain cardio selectivity, there would be no need for change with pharmacotherapy.
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