case of COPD exacerbation

Introduction

A 67 yo man seen in ED with 2 day history of fever, dyspnea, & increased production greenish-yellow sputum.

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

Dosage

• 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

Diagnostic procedures

• 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

More general terms

• case presentation