Glaucoma

Patient comes in for a recheck today from his recent visit of September 30, 2015. At that time, we had prescribed him Breo 100 mcg one puff in the morning to help resolve some of his persistent asthma symptoms. He also uses Spiriva every morning and albuterol as needed up to four times a day. He states that he does feel better with Breo and likes this medication, although he still has some complaint of shortness of breath and chest tightness occasionally. He feels that it seems to be related to changes in barometric pressure and temperature changes when he has his worsening days. He uses his albuterol as needed when he has this feeling and it does seem to help well. He does sometime uses Spiriva as well at an increased dose and does not feel that this helps. Otherwise, he is doing very well and would like to continue with this treatment plan to give him the best lung function as possible.

ASSESSMENT:
1. Moderate to severe persistent asthma.
2. Allergic rhinitis.
3. Allergic conjunctivitis.
4. Hypertension.
5. Glaucoma.

PLAN:
1. I would like to try to increase his Breo to 200 mcg one puff in the morning to see if he has any added relief with the higher dose of this combination medication. He is to inform me if he feels that this gives him more relief in two weeks time. If not then we may reduce the dose so we prevent any overmedication for this older man.
2. He also does allergy immunotherapy with us and feels that it is making a difference with his allergic triggers to his asthma and so we will continue with the allergy immunotherapy.
3. He can also continue with the albuterol every four to six hours as needed as well as Spiriva every morning to also help improve his lung function and manage his COPD.
4. We will follow up in six weeks time to see how he is working.

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