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How are exacerbations of COPD managed?

Q: A 52 years old thin built woman came to the Casualty Department presenting with fever, malaise, productive cough (yellowish), severe chest pain and breathlessness. She has lung TB since childhood. She is also a known case of COPD - Bronchial Asthma and is on Deriphylline and sometimes needs to nebulise. Medical history was taken and two courses of antibiotics like Amox and Cipro have been given but with no improvement. On examination - She is weak/thin, febrile, BP 110/70 mmHg, no periphery cyanosis, chest - crepts ++, CVS - s1, s2, no murmur, abdomen - soft, and no oedema was found. She has been advised to do blood test for RE/ESR/Widal, CXR, Sputum for AFBx3 and C/S. My impression is Chronic COPD - Bronchial Asthma with Recurrent Pneumonia. What could be the provisional diagnosis? Which is the most appropriate treatment for her? What other investigations need to be done?

A:Exacerbation of COPD are often caused by viral infection and the initial X-ray may not show an infiltrate. Frequently, a secondary bacterial infection supervenes causing tracheobronchitis, and this may progress to pneumonia and even respiratory failure that necessitates intubation and mechanical ventilation. A parapneumonic effusion can occur as a complication and may progress to an empyema. Certain bacteria including Pneumococci, anaerobes and Staphylococci can cause pneumatocoeles or a lung abscess. Other infectious complications include sinusitis and nosocomial super infection, particularly in hospitalised patients. Besides antibiotics and broncho dilators, corticosteroids may be needed. Procedures may include bronchoscopy especially if an obstructive lesion or cancer is a concern. For empyema, a CT scan is needed and a chest tube, thoracoscopy or surgical intervention may be necessitated in complicated cases.

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