Pulmonary Disorders II

(fever, purulent sputum) and a severe ECOPD with

respiratory failure. This patient has a history of anaphy-

lactic reaction to penicillin and repeated exacerbations

that may predispose her to resistant organisms such as

P. aeruginosa (Answers A and B are incorrect); there-

fore, levofloxacin would be the best recommendation

(Answer D is correct).

Answer: A

The current GOLD guidelines provide specific diagnos-

tic parameters to determine the severity of an ECOPD.

A respiratory rate greater than 24 breaths/minute and

an Spo2 less than 92% on home oxygen therapy clearly

identify this patient as having either a moderate or

severe asthma exacerbation. Patients with a moderate

ECOPD may have hypercapnia (Paco2 greater than 45

mm Hg) or hypoxia (Pao2 less than 60 mm Hg); how-

ever, they have not yet developed acidosis (pH less than

7.35), whereas those experiencing a severe ECOPD have

developed acidosis (Answers C and D are incorrect).

Although the degree of respiratory failure is determined

using many of the same parameters as the severity of

ECOPD, there is a greater focus on patient response to

therapy. An improvement in hypoxemia with noninva-

sive ventilation by Venturi mask with an Fio2 greater

than 35% and the absence of an altered mental status are

associated with non–life-threatening respiratory failure

(Answer B is incorrect; Answer A is correct).