Respiratory Symptoms in an Older Adult

P.E. is a 74-year-old female new patient who scheduled an appointment to establish primary care after enrolling in a Medicare HMO plan. She arrives in mild to moderate respiratory distress with an acute, severe productive cough and wheezing. She reports long-standing asthma and COPD, currently smokes 3–5 cigarettes/day, and recently ran out of her budesonide/formoterol (Symbicort®) inhaler. She has not had regular medical care for years and often obtains care and medications while traveling internationally.