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hospitalized patients
E) dont know
2nd question
What is the most likely initial antibiotic that patients with
AECOPD and infection is suspected to be the trigger admitted to
your hospital will receive
A) Amoxicillin-clavulinic acid
B) Ceftriaxone + Clarithromycin
C) 3rd generation cephalosporin alone
D) 2nd generation cephalosporin alone
E) a respiratory quinolone ( levofloxacin- Moxifloxacin )
3rd question
purulence
type 2 : presence of two of these symptoms,
to 3.94],
malignant disease (risk ratio, 1.82 [CI, 1.13 to 2.92])
Management issues
Acute exacerbation of COPD
treatment
Oxygen therapy
Pharmacological intervention
Bronchodilators
Steroids
Antibiotics
methylxanthines
Assisted ventilation
Non invasive
invasive
Treatment : oxygen therapy
Response to oxygen administration 3 possible
outcomes
The patient's clinical state and PaCO2 may improve or not
change
The patient may become drowsy but arousable in these
cases, the PaCO2 generally rises slowly by up to 20 mmHg
and then stabilizes after approximately 12 hours
The patient rapidly becomes unconscious, cough becomes
ineffective, and the PaCO2 rises at a rate of 30 mmHg or
more per hour
complete withdrawal of oxygen if hypercapnea
worsens is more dangerous .
Effects of the administration of O2 on ventilation and blood gases
in patients with chronic obstructive pulmonary disease during acute
respiratory failure.
Aubier M et al , Am Rev Respir Dis. 1980;122(5):747.
On discharge On discharge
On admission
On admission
Conclusion
Steroid therapy does have moderate benefit in
AECOPD.
2 wks. therapy is similar to 8 wks.
There is significant hyperglycemia in the steroid
group.
A number of patients in the 8 wks. Group was
admitted for serious infection.
Short-term vs conventional glucocorticoid therapy in
acute exacerbations of chronic obstructive pulmonary
disease: the REDUCE randomized clinical trial.
Leuppi JD et al , JAMA. 2013 Jun;309(21):2223-31.
Time to re-exacerbation
Short-term vs conventional glucocorticoid therapy in acute
exacerbations of chronic obstructive pulmonary disease: The
Deathrandomized clinical trial.
REDUCE Death or exacerbation
Leuppi JD et al , JAMA. 2013 Jun;309(21):2223-31.
Survival curve
Short-term vs conventional glucocorticoid therapy in acute
exacerbations of chronic obstructive pulmonary disease: The
REDUCE randomized clinical trial.
Leuppi JD et al , JAMA. 2013 Jun;309(21):2223-31.
FEV1
Steroid dose for exacerbation
Conclusion
Systemic steroid
Oral treatment is as effective as IV.
If you use IV , restrict to 24 or 48 hrs.
5 days is adequate
NO need for tapering or overlap
Inhaled steroid
There is no evidence for concomitant
addition of nebulized steroid during
exacerbation
Use of antibiotics
indication for starting antibiotics
Frequency of pathogens