Question: A 67-year-old Woman Is Evaluated In The Emergency Department For A 2-day History Of Fever, Dyspnea, And Increased Cough With Production Of Green Sputum. She Has Severe COPD, Which Was Diagnosed 2 Years Ago. She Used Albuterol Several Times Yesterday With No Relief Of Dyspnea, And She Was Unable To Sleep Last Night. Her Last Spirometry, Performed 6 Months …

A 67-year-old woman is evaluated in the emergency department for a 2-day history of fever, dyspnea, and increased cough with production of green sputum. She has severe COPD, which was diagnosed 2 years ago. She used albuterol several times yesterday with no relief of dyspnea, and she was unable to sleep last night. Her last spirometry, performed 6 months ago, showed an FEV1 of 48% of predicted. She is a current smoker. 1- What is Spirometry? When it should be done? 2- What other medication could be prescribed for this patient to relieve her Symptoms? 3- Indicate the mechanism of action of the selected drug? 4- What are the possible side effects of this medication? 5- What advice can you give to this patient?