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NR 565 Week 6 Discussion: COPD Case Study Analysis
Describe your assigned client’s situation. Why are they presenting to the clinic? What
medications are they currently taking?
Kia Tadesse, a 67-year-old woman with a history of COPD, came in for a follow-up following a
two-day hospital stay due to a COPD exacerbation. She was hospitalized for the second time in
a year despite taking her medication (olodaterol/tiotropium, or Stiolto Respimat) as prescribed.
She comes to the clinic to avoid further exacerbations. Her plasma eosinophil level of 350
cells/µL according to her lab results, is a crucial sign for possible therapy modifications.
Client is feeling better after being discharged and wants to avoid more episodes. Physical
Findings: Auscultation reveals bilateral expiratory wheezes without retractions. Vital signs:
stable with a slightly elevated respiratory rate of 22. History: No allergies; stopped smoking a
year ago. Present medications: Stiolto Respimat (Olodaterol/Tiotropium) 2.5 mcg/2.5 mcg, two
puffs daily.
Discuss your personal professional assessment of the client’s situation provided in the
scenario. What pharmacological treatment is necessary and why?
According to the clinical scenario given, Kia Tadesse is adhering to an effective dual
bronchodilator therapy (Stiolto Respimat: olodaterol/tiotropium) but is having frequent, severe
exacerbations (two hospitalizations in a single year). According to the patient's test results, her
plasma eosinophils are 350 cells/µL. This level of blood eosinophilia, when paired with a history
of repeated exacerbations, functions as a "treatable trait," according to GOLD 2024
recommendations, suggesting a high probability of a positive response to inhaled
corticosteroids (ICS).
To lower the risk of future exacerbations, switch to or add an ICS to her existing long-acting
bronchodilator medication (e.g., Triple therapy: LABA/LAMA/ICS). Research indicates that when
an ICS is added to the regimen, COPD patients with blood eosinophil levels ≥300 cells/µL see
improvements in lung function and significant reductions in exacerbation rates (up to 43%). She
is considered a high-risk patient due to her two hospital stays in a single year. It has been
demonstrated that triple therapy (LABA/LAMA/ICS) reduces moderate-to-severe exacerbations
in this patient group more effectively than dual therapy (LABA/LAMA). She continues to have
exacerbations and bilateral expiratory wheezes despite careful adherence to Stiolto Respimat
(LABA/LAMA), indicating persistent eosinophilic airway inflammation that calls for switching to
triple therapy.
NR 565 Week 6 Discussion: COPD Case Study Analysis
Describe your assigned client’s situation. Why are they presenting to the clinic? What
medications are they currently taking?
Kia Tadesse, a 67-year-old woman with a history of COPD, came in for a follow-up following a
two-day hospital stay due to a COPD exacerbation. She was hospitalized for the second time in
a year despite taking her medication (olodaterol/tiotropium, or Stiolto Respimat) as prescribed.
She comes to the clinic to avoid further exacerbations. Her plasma eosinophil level of 350
cells/µL according to her lab results, is a crucial sign for possible therapy modifications.
Client is feeling better after being discharged and wants to avoid more episodes. Physical
Findings: Auscultation reveals bilateral expiratory wheezes without retractions. Vital signs:
stable with a slightly elevated respiratory rate of 22. History: No allergies; stopped smoking a
year ago. Present medications: Stiolto Respimat (Olodaterol/Tiotropium) 2.5 mcg/2.5 mcg, two
puffs daily.
Discuss your personal professional assessment of the client’s situation provided in the
scenario. What pharmacological treatment is necessary and why?
According to the clinical scenario given, Kia Tadesse is adhering to an effective dual
bronchodilator therapy (Stiolto Respimat: olodaterol/tiotropium) but is having frequent, severe
exacerbations (two hospitalizations in a single year). According to the patient's test results, her
plasma eosinophils are 350 cells/µL. This level of blood eosinophilia, when paired with a history
of repeated exacerbations, functions as a "treatable trait," according to GOLD 2024
recommendations, suggesting a high probability of a positive response to inhaled
corticosteroids (ICS).
To lower the risk of future exacerbations, switch to or add an ICS to her existing long-acting
bronchodilator medication (e.g., Triple therapy: LABA/LAMA/ICS). Research indicates that when
an ICS is added to the regimen, COPD patients with blood eosinophil levels ≥300 cells/µL see
improvements in lung function and significant reductions in exacerbation rates (up to 43%). She
is considered a high-risk patient due to her two hospital stays in a single year. It has been
demonstrated that triple therapy (LABA/LAMA/ICS) reduces moderate-to-severe exacerbations
in this patient group more effectively than dual therapy (LABA/LAMA). She continues to have
exacerbations and bilateral expiratory wheezes despite careful adherence to Stiolto Respimat
(LABA/LAMA), indicating persistent eosinophilic airway inflammation that calls for switching to
triple therapy.
