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CONSIDERATIONS FOR CHOICE
IMPACT OF COPD EXACERBATION
• Hospital mortality of patients admitted for
10%, and the long-term outcome is poor.
longer average hospital stays in patients
• Patients with a severe exacerbation of
• In a healthcare utilization study (2000 -2001),
COPD that requires mechanical ventilation
COPD patients were hospitalized more often
from respiratory illnesses than those without
such as enteric gram-negative bacilli and
COPD (11.8% vs 0.5%). They were also more
, may be more frequent1
An approach for determining if antibiotics
• If Pseudomonas
spp and/or other
should be initiated for patients with an
• Antibiotics should be considered for patients
acute exacerbation of chronic obstructive
Global Initiative for Chronic Obstructive Lung Disease (GOLD).
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive
(Updated 2006). www.goldcopd.org. Accessed March 7, 2007.2.
Yu-Isenberg KS, Vanderplas K, Chang EY, Shah H. Utilization and medical care
expenditures in patients with chronic obstructive pulmonary disease: a managedcare claims data analysis. Dis Manage Health Outcomes
. 2005;13:405- 412.
Tinkelman DG, George D, Halbert RJ. Chronic obstructive pulmonary disease
in patients under age 65: utilization and costs from a managed care sample.
J Occup Environ Med.
Cel i BR, MacNee W, and ATS/ERS
Task Force committee members. Standards for the diagnosis and
— Providing educational strategies that
treatment of patients with COPD: a summary of the ATS/ERS position paper.Eur Respir J.
improve patient adherence to medicationand management regimens includingtaking medication appropriately,
Boehringer Ingelheim Pharmaceuticals, Inc. has no ownership interest
in any other organization that advertises or markets its disease
pulmonary rehabilitation, undertaking and
A healthcare practitioner educational resource provided by
Boehringer Ingelheim Pharmaceuticals, Inc.
devices such as nebulizers, spacers, andoxygen concentrators properly1
C Printed on recycled paper in the U.S.A.
Copyright 2007, Boehringer Ingelheim Pharmaceuticals, Inc.
DM45623.qxd:BOE-7007B_DM45623_AcuteExcrbt 11/16/09 10:10 AM Page 2
Rationale and Patient Assessment for Antibiotic
Figure 2. Antibiotic treatment in exacerbations
ACUTE COPD EXACERBATION
• Randomized placebo-control ed studies of antibiotic treatment in
(No particular order) (No particular order) (No particular order)
• COPD is often associated with worsening
exacerbations of COPD have demonstrated a beneficial effect of
• Antibiotics are recommended only when patients with worsening
• According to the 2006 Global Initiative for
dyspnea and cough also have increased sputum volume and purulence
Guidelines, patients with Stage I: Mild
• Prophylactic and continuous use of antibiotics have no effect on the
frequency of COPD exacerbations. Thus, the use of antibiotics, other
COPD to Stage II: Moderate COPD
than for treating infectious exacerbations of COPD and other bacterial
associated with worsening airflow limitation
with shortness of breath due to exertion,
Figure 1. Stratification of patients with COPD
sometimes also present. Patients typically
exacerbated for antibiotic treatment and potential
seek medical attention because of chronic
microorganisms involved in each group.1
• In Stage III: Severe COPD,
an exacerbation is
characterized by further worsening of airflow
limitation, greater shortness of breath, reduced
• An exacerbation in Stage IV: Very
is commonly associated
with severe airflow limitation and chronic
respiratory failure. At this stage, these
a. Al patients with symptoms of a COPD exacerbation should be treated with additional bronchodilators ± glucocorticosteroids.
b. Classes of antibiotics are provided (with specific agents in parentheses). In countries with high incidence of S. pneumoniae
resistant to penicil in, high dosages of Amoxicil in or Co-amoxiclav are recommended. (See Figure 1 for definition of Groups
c. Cardinal symptoms are increased dyspnea, sputum volume, and sputum purulence.
d. This antibiotic is not appropriate in areas where there is increased prevalence of ß-lactamase producing H. influenzae
and/or of S. pneumoniae
resistant to penicil in.
e. Not available in al areas of the world.
a. Risk factors for poor outcome in patients with COPD exacerbation: presence of comorbid diseases, severe COPD, frequent
f. Dose 750 mg effective against P. aeruginosa
exacerbations (>3/yr), and antimicrobial use within last 3 months.
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1. What is a change in the number of entire chromosome sets called?a. Aneuploidyb. Euploidyc. Monosomyd. Trisomye. Deficiency2. What is an individual with only one set (n) of chromosomes called?a. Triploidb. Monosomicc. Trisomicd. Haploide. Polyploid3. Bread wheat is an allohexaploid. What is its most likely origin?a. Tripling the original diploid number by use of colchicineb. Crossing with o