Pulmonology eConsult
COPD with Congestive Heart Failure
SPECIALTY
Pulmonology eConsult
CHIEF COMPLAINT
COPD with Congestive Heart Failure
COMMENTS TO SPECIALIST
79-year-old female with COPD, Congestive Heart Failure (CHF), pulmonary hypertension, Peripheral Vascular Disease (PVD), lymphedema, Gastroesophageal Reflux Disease (GERD), Stage 4 Chronic Kidney Disease (CKD4), hyperlipidemia, and gout.
She has recurrent COPD exacerbations and is treated with Prednisone 40 mg po daily for 5 days. Received 40 mg of prednisone on Monday, 20 mg on Tuesday, 20 mg on Wednesday, and 40 mg today. She is chronically on Pulmicort nebulizer 0.5 bid and Duoneb qid. Recently, she began Z-pack treatment. She has increased congestion, wheezing, productive cough, thick green sputum, and shortness of breath with conversation.
Her O2 saturation is 90% baseline with O2 at 4L at night. Chest X-ray was negative. She continues to have shortness of breath with wheezes and rhonchi noted. Tight cough is productive of thick green/brown sputum. The patient was treated in Jan with 5 days of prednisone and Augmentin. Her symptoms improved slightly but have once again exacerbated.
MAIN QUESTION
- Should doxycycline be added despite a negative chest x-ray but with coarse wheezes and rhonchi to oscillation?
- Would Acetylcysteine in the short term be more beneficial in helping her to expect and improve symptoms?
- Recommendations to better manage her end-stage COPD since she is unable to use inhalers?
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