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case of COPD exacerbation
A 67 yo man seen in ED with 2 day history of fever, dyspnea, & increased production greenish-yellow sputum.
Past medical history:
- COPD diagnosed 5 years previously
- 25 pack year history of smoking, quit 5 years ago
- hypertension
- coronary artery disease
- heart failure
- depression
Physical examination:
- temperature: 38.8 C
- blood pressure 122/84
- pulse 116/min
- auscultation: diffuse expiratory wheezing
Medications:
- albuterol MDI PRN
- tiotropium MDI
- lisinopril
- carvedilol
- simvastatin
- sertraline
- aspirin
Laboratory:
- CBC non-contributory
- basic metabolic panel - non contributory
- O2 saturation is 81% on room air
- O2 saturation improved to 90% after albuterol nebulizer & 2L O2 by nasal cannula
Special laboratory:
- spirometry 1 year ago: FEV1 of 48%
Radiology:
- chest X-ray shows no infiltrate
Complications:
- risk of hospital readmission for COPD exacerbation increased by comorbidities
Management:
- antibiotics plus glucocorticoids
- azithromycin (Zithropac) vs 7 days of antibiotics (doxycycline, fluoroquinolone ..)
- 5 days of glucocorticoids sufficient
- short-acting bronchodilator
- supplemental oxygen
- pulmonary rehabilitation after hospitalization
- immunizations
- PCV13 followed by PPSV23 in 1 year
- Herpes zoster vaccine
- Tdap
- annual influenza vaccine
General
case presentation