Problem: Rick is a 54 y.o. old male who comes to the clinic with a complaint of allergies and asthma. He has had mild intermittent asthma for years that is triggered by allergies and respiratory infections. The past few weeks his seasonal allergies have been bothering him, and he has been using his albuterol a couple times a day for a wheezy cough. He has been taking Benadryl for his allergies, but doesn't like it because it makes him sleepy and he cannot take it and work. He is able to work, but he said he cannot finish his routine 5-mile run each day due to coughing.
He is afebrile, his oxygen saturation is 95% on room air, his in-office spirometry indicates his FEV1 is 75% of predicted.
His only medications are the albuterol inhaler and Benadryl.
What would be the appropriate prescription for him today?
What type of ongoing monitoring will he need?
What education will he need?
What vaccines would you recommend for this patient?
How would this presentation differ if you suspected pneumonia and what would be your pharmacological regimen if you highly suspected Community Acquired Pneumonia?