What Treatment Devices Would You Recommend to a Patient with Asthma and Allergic Rhinitis Who Has Severe Arthritis and Stroke History?

A 58 yo male with asthma and allergic rhinitis reports difficulty using his asthma inhalers and nasal spray.

He has a history of DM2, allergic rhinitis, mild asthma, severe arthritis of the hands, and a R hand weakness secondary to remote stroke.

Medications:

Nasacort (triamcinolone), Albuterol MDI, glyburide, rosiglitazone

Physical examination:

HEENT: Pale boggy turbinates with 75% obstruction of the nasal cavity
Chest: CTA (B)
Extremities: severe arthritis of both hands, and a R hand weakness secondary to remote stroke.


A hand with arthritic changes. Image source: Cicadas, a Creative Commons license.

What would you recommend to this patient?

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