Upper Resp Infections: Acute Exacerbation of COPD Flashcards
What is AECOPD?
- Acute worsening of resp symptoms that require additional therapy
- Usually precipitate by a viral or bacterial infection
- Can be Mild, Moderate, or Severe
Infection + Inflammation = Exacerbation
Risk factors for Exacerbations (after infection)
- Asthma/COPD overlap
- Allergic phenotypes
- High degree of inflammation
- Past Exacerbations (single best predictor)
- Chronic bronchitis
Is AECODP pathogen most likely Viral or Bacterial?
Viral: Rhinovirus (esp in winter), influenza
-Eosinophilia is associated with higher risk of viral infection. May respond well to steroid therapy.
What bacteria are implicated in AECOPD
H. Flu (biofilm in lungs), Strep. Pneumoniae, P. aeruginosa (esp in pts with bronchiectasis).
What AECOPD pts should get abx?
Resp symptoms plus evidence of bacterial infxn: short course of 5-7 days is beneficial. Not clear which patients will derive the most benefit.
How to stage COPD?
Use the “GOLD” system
- Global Initiative for Chronic Obstructive Lung Disease
- 4 categories A, B, C, D., based on symptoms and risk of exacerbation
Who is at high risk for Pseuomonas with AECOPD?
Pts with:
- Recent ABX therapy
- recent hospitalization
- bronchiectasis
Agents of choice for AECOPD?
For pts at low risk of pseudomonas:
-Augmentin, tetracycline, Macrolide 5-7 days
High risk of pseudomonas:
-Cipro, Levaquin 5-7 days
What about Corticosteroids in AECOPD?
Remember AECOPD = infection + INFLAMMATION
- Improves outcomes
- PO is just as good as IV
- 5 days is good: Short course is as good as long course. More than 7 days requires taper.
What about abx prophy for AECOPD?
- Can do Azithromycin 250 mg TIW or Moxifloxacin pulse (400 mg daily for 8 weeks).
- Azith preferred
What about prevnetion?
PPSV23 is recommended for all patients with COPD
What adults should get pneumococcal vaccine?
Anyone over 65
All adults who have chronic illness, even < 65
