RT is a 63-year-old woman with a medical history of asthma, hypertension, and hypothyroidism. Her medications include Advair (fluticasone propionate and salmeterol) 250/50, 1 inhalation every 12 hours; albuterol, 1 to 2 puffs every 4 hours as needed for shortness of breath or wheezing; aspirin 81 mg daily; levothyroxine 50 mcg daily; and lisinopril/hydrochlorothiazide (HCTZ) 25/12.5 mg daily.
As RT is picking up her levothyroxine and lisinopril/HCTZ from her pharmacy, she casually mentions that her asthma medication is not working lately. When the pharmacist asks her what she means, she explains that she does not like the taste of the albuterol inhaler that she uses when she is at high altitudes or during high-pollution days. She also states that the Advair "does not do anything," because she "does not feel anything" when she uses it.
The pharmacist looks at RT?s refill history and discovers that she has not refilled her albuterol inhaler in the past 6 months. The pharmacist asks RT how often she uses her albuterol and Advair inhalers. RT states she goes to
One study linked multiple pregnancies to an increased risk of developing atrial fibrillation later in life, and another investigated the association between premature delivery and cardiovascular disease.
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