Medical Treatment Algorithm for Chronic Obstructive Pulmonary Disease Initial medical treatment of chronic obstructive pulmonary disease (COPD) is guided by severity of obstruction, symptom burden, and exacerbation risk with escalation in therapy targeted to control persistent symptoms or further exacerbations. Exacerbation severity is differentiated by the location of treatment, with moderate exacerbations treated in the outpatient setting with oral corticosteroids, antibiotics, or both and severe exacerbations requiring hospitalization or emergency department care. Additional therapies such as azithromycin and roflumilast can be considered for select patients who continue to experience exacerbations despite optimal inhaled therapy. Further therapies such as azithromycin and roflumilast can be considered in select patients with persistent exacerbations despite maximal inhaled therapy. BMI indicates body mass index, calculated as weight in kilograms divided by height in meters squared; CAT, COPD assessment test; FEV1, forced expiratory volume in the first second of expiration; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; SABA, short-acting β2-agonist; SAMA, short-acting muscarinic antagonist. #COPD #Treatment #Algorithm #Management #Pulmonary #LABA #LAMA #SABA #SAMA #ICS #Pharmacology

Acute Purpura Fulminans Skin Rash on Physical Exam 60 year old male ITP s/p splenectomy 1d chills/rigors, diarrhea, nausea. 2hrs later, develops a new full-body rash. No sick contacts, travel. Recent tick bite. Cat at home. No raw seafood. Admitted to ICU in multipressor shock. Ddx? Ddx is very broad! A key here is what can lead to the rash (purpura fulminans) and critical illness. Here are a few leading thoughts on the list: Strep pneumo, N.meningitidis, Vibrio, aeromonas, Capnocytophaga, RMSF Another pit stop here to think about high risk pathogens in setting of asplenia. Your blood cxs identify GNR and pt slowly improving on abxs. Final dx: Septic shock, multiorgan system failure, purpura fulminans secondary to Capnocytophaga! - BIDMC Infectious Diseases Fellowship @BIDMC_IDFellows #Capnocytophaga #Purpura #Fulminans #Skin #Rash #clinical #photo