1. Incorrect. A heart rate increase of greater than 20 beats per minute is considered an adverse reaction. Therapy should be adjusted.
2. Incorrect. Advair includes a long acting bronchodilator and a corticosteroid. Neither of these ingredients are indicated for a patient with an acute exacerbation because they take to long to bronchodilate.
3. Correct. Choosing another drug in the same class with less cardiac side effects would be the best choice. However, this choice is not available. Therefore, of the available answers, decreasing the dosage of albuterol is the best choice.
4. Incorrect. Ipratropium bromide may be a good addition to Albuterol, but not a good replacement. Ipratropium is indicated for maintenance treatment of COPD, not for acute exacerbations. This patient is still wheezing and still needs a quick acting bronchodilator such as Albuterol, or levalbuterol.