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A 58-year-old man with α1-antitrypsin deficiency is evaluated in the emergency department for increased shortness of breath, cough, increased sputum production and purulence. His medications include tiotropium and albuterol. He has received weekly intravenous α1-antitrypsin replacement therapy for the past year with no complications; he has received four courses of antibiotic therapy in the past year for acute exacerbations of COPD, and he is taking continuous oxygen. The FEV1 is 0.8 L.

Which of the following is the most appropriate management for this patient?

A Hospitalization; treat with systemic corticosteroids and antibiotics with coverage for gram-negative rods
B Hospitalization; treat with systemic corticosteroids and a second-generation cephalosporin
C Treat at home with prednisone and amoxicillin
D Treat at home with prednisone and a macrolide antibiotic

d? what the answer laptoping?

I will give ans after a few more people have answered this question.

d , I guess

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il go with B.

A)))))))))))))))))))))

I think is B
What is the answer?

is ans B

The correct ans is AAAA

Patients with stage 4 COPD who experience acute exacerbation should be treated like patients with community-acquired pneumonia. The exacerbation could result in death or respiratory failure. Therefore he should be hospitalized. The fact that he had four exacerbations in the past year, used multiple antibiotics, and has α1-antitrypsin deficiency, and stage 4 COPD increases the likelihood that the organism will be a gram-negative rod such as Pseudomonas. Cephalosporins, although adequate for most exacerbations of COPD, might not cover gram-negative rods. At-home treatment might be appropriate for patients with stage 1 and 2 with acute exacerbations. For those with more advanced disease however, hospitalization is necessary because of the possibility of respiratory failure.