Problem: For a patient who uses albuterol MDI approximately 3-4 days per week over the past 2 months, which progressed to using albuterol once daily with shortness of breath during exercises and triggers from mild saw dust and a morning peak flow personal best of 400L/min. Medication are as follows Flovent HFA 44 mcg, two puffs BID.
Proventil HFA two puffs Q 4-6 H PRN shortness of breath, cough, wheezing
Propranolol 80 mg PO BID
Maxalt-MLT 5 mg PO PRN acute migraine
Would you suggest the addition of a long-acting once daily antimuscarinic inhaler in this case? If so, what's your recommended treatment?