MONTREAL — Exacerbations of chronic obstructive pulmonary disease may need more aggressive therapy when they co-occur with pneumonia, said Dr. Charles Chan, professor of medicine at the University of Toronto and head of respirology at University Health Network and Mount Sinai Hospital in Toronto.
Chronic obstructive pulmonary disease (COPD) can predispose patients to pneumonia, but differentiating between the two conditions can be difficult, Dr. Chan said at an international conference on community-acquired pneumonia.
“COPD exacerbations alone are generally recognized, but with pneumonia, they may be underappreciated” and thus undertreated, Dr. Chan said in an interview at the meeting, sponsored by the International Society of Chemotherapy.
Guidelines for treating mild exacerbations of COPD (Can. Respir. J. 2004;11[suppl. B]:3B-59B) recommend antibiotic treatment with macrolides, but only in the presence of purulent sputum.
In contrast, the guidelines for community-acquired pneumonia (CAP) in older patients with comorbidities such as COPD suggest that fluoroquinolones be administered to the patient (Clin. Infect. Dis. 2007;44:S27-S72).
But recognizing CAP in a patient with COPD exacerbation can be tricky.
“You can see the differences on x-ray, but even this can be subtle, and if you don't do an x-ray, …it is hard to tell the difference,” he said in the interview.
COPD exacerbation involves hyperinflated lungs (left); concurrent pneumonia involves nodular infiltrates (right). Photos courtesy Dr. Charles Chan
