03-15-2008, 08:37 PM
The correct answer is E. Patients with chronic disease, particularly chronic lung disease, should receive a pneumococcal vaccine once and then a repeat booster shot after age 65 years.
Antibiotics (choice A) have not been shown to have beneficial effect in COPD when used for prophylaxis. This patient has received a 5-day course of azithromycin, which is more than adequate for AECB (traditionally treatment has been for 5 days, though current recommendations are for 3 days of higher dose treatment).
Home oxygen therapy (choice B) has been shown effective only in patients with severe COPD, as evidenced by a baseline pO2 of less than 55 mm Hg. This patient has adequate, though reduced, oxygenation and is unlikely to benefit from (or qualify for) home oxygen therapy.
Inhaled steroids (choice C) are commonly used but rarely beneficial in COPD. Asthma, a predominantly eosinophilic inflammation, responds better to steroids than the neutrophilic inflammation of COPD. If this patient™s chronic condition worsens, he may benefit from a trial of oral steroids to gauge steroid responsiveness, and then may benefit from a transition to an inhaler.
Leukotriene modulators (choice D) work on an inflammatory cascade seen more in asthma than in COPD, and would be of little benefit in this patient.
Antibiotics (choice A) have not been shown to have beneficial effect in COPD when used for prophylaxis. This patient has received a 5-day course of azithromycin, which is more than adequate for AECB (traditionally treatment has been for 5 days, though current recommendations are for 3 days of higher dose treatment).
Home oxygen therapy (choice B) has been shown effective only in patients with severe COPD, as evidenced by a baseline pO2 of less than 55 mm Hg. This patient has adequate, though reduced, oxygenation and is unlikely to benefit from (or qualify for) home oxygen therapy.
Inhaled steroids (choice C) are commonly used but rarely beneficial in COPD. Asthma, a predominantly eosinophilic inflammation, responds better to steroids than the neutrophilic inflammation of COPD. If this patient™s chronic condition worsens, he may benefit from a trial of oral steroids to gauge steroid responsiveness, and then may benefit from a transition to an inhaler.
Leukotriene modulators (choice D) work on an inflammatory cascade seen more in asthma than in COPD, and would be of little benefit in this patient.