Organisms Causing Infection In A Patient With COPD.

Which of the following infections is least likely in a patient with COPD?

A) Streptococcus pneumoniae
B) Haemophilus influenzae
C) Moraxella catarrhalis
D) Mycoplasma pneumoniae

Answer and Discussion

The answer is D. Mycoplasma pneumoniae

COPD is a disease process involving progressive chronic airflow obstruction because of chronic bronchitis, emphysema, or both.
Chronic bronchitis is defined clinically as excessive cough and sputum production on most days for at  least 3 months during at least 2 consecutive years.
Emphysema is characterized by chronic dyspnea resulting from the destruction of lung tissue and the enlargement of air spaces.
Asthma, which features airflow obstruction, airway inflammation, and increased airway responsiveness to various stimuli, may be distinguished from COPD by reversibility of pulmonary function deficits.
Acute exacerbations of COPD are treated with oxygen (in hypoxemic patients), inhaled β2 agonists, inhaled anticholinergics, antibiotics, and systemic corticosteroids. Theophylline may be considered in patients who do not respond to other bronchodilators.
Antibiotic therapy is directed at the most common pathogens, including

• Streptococcus pneumoniae, 
• Haemophilus influenzae, and 
• Moraxella catarrhalis. 

Mild-to-moderate exacerbations of COPD are usually treated with broad-spectrum antibiotics such as doxycycline, trimethoprimsulfamethoxazole, and amoxicillin-clavulanate potassium.Treatment with
extended-spectrum penicillins, fluoroquinolones, third-generationcephalosporins, or aminoglycosides may be considered in patients with severe exacerbations.

The management of chronic stable COPD includes smoking cessation and oxygen therapy. Inhaled β2 agonists, inhaled anticholinergics, and systemic corticosteroids are also used in patients with
chronic stable disease. Inhaled corticosteroids decrease airway reactivity and can reduce the use of health care services for management of respiratory symptoms. Avoiding acute exacerbations helps to reduce longterm complications. Long-term oxygen therapy, regular monitoring of pulmonary function, and referral for pulmonary rehabilitation are often utilized and can improve the quality of life and reduce hospitalizations.
Influenza and pneumococcal vaccines should be administered.
Selected patients who do not respond to standard therapies may benefit from lung reduction surgery.