72 year old male with CAD, DM, COPD/Asthma with worsening COPD symptoms.
He has had 4 exacerbations requiring prednisone bursts or tapers from various providers in the past 3 months. When he completes taper, typically feels worse after about 2 days. At prior baseline had 1 block exercise tolerance and now gets breathless with walking around the house with a walker.
I feel that I might have reached max medical management within primary care. I think his cardiac disease is stable, but COPD may be progressing to the point of needing chronic prednisone.
Would you start this patient on chronic prednisone, and at what dose? Any other medications to try?