Chronic Obstructive Pulmonary Disease With Severe Airflow Limitation and Chronic Antitussive Use: Challenges in Diagnosis, Treatment Adherence, and Inhaler Technique: A Case Report

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disorder that imposes a substantial burden on patients’ quality of life, and whose effective management relies heavily on adherence to treatment and correct inhaler technique. We report the case of an 88-year-old woman with multiple comorbidities who had previously been diagnosed with asthma despite having neither undergone spirometry nor received inhaled therapy. Although she denied significant respiratory symptoms, her granddaughter reported chronic cough, wheezing, and dyspnea. Further evaluation revealed daily use of a codeine-phenyltoloxamine combination for approximately 10 years. Pulmonary function testing confirmed the diagnosis of COPD. The patient's clinical course was marked by difficulty discontinuing the antitussive medication and, following initiation of inhaled therapy, by poor adherence and incorrect inhaler use. Multiple therapeutic adjustments were required, including the introduction of a valved holding chamber, adjunctive mucolytic therapy, and escalation to triple inhaled therapy after a moderate exacerbation. Sustained symptomatic improvement and successful discontinuation of the antitussive were achieved only after repeated patient education, correction of inhaler technique, and dose adjustment. This case highlights the importance of a multidimensional approach to COPD management, emphasizing the role of patient education and empowerment, regular assessment of inhaler technique, and longitudinal follow-up, particularly in older adults and in patients dependent on non-recommended medications.