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What to do if pneumonia persists in elderly male with COPD?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

My father is 76 years old. He has been in the intensive care unit (ICU) for two days as he was diagnosed with lower respiratory tract infection (LRTI) (CAP - community-acquired pneumonia). Four years back, he had tuberculosis (TB). His vitals, such as blood pressure (BP), temperature, and renal and heart tests, are fine. He is not responding to antibiotics, and his condition is deteriorating. His saturation has dropped to 82%, and he was put on oxygen. On the third day, he was given Amoxicillin 1000 IV and 5x nebulization and then switched to Piperacillin-Tazobactam IV, which I have read is for Pseudomonas. Pseudomonas aeruginosa is a commonly acquired hospital bacterium. Doctors admit they have not yet identified the bacteria from the sputum culture and are told it will take more than five days to identify the bacteria.

Please help.

Answered by Dr. Amol Kumar Wasudeorao Diwan

Education:

MBBS

Professional Bio:

Dr. Amol Kumar Wasudeorao Diwan is a qualified Specialist in Pulmonary Medicine, Tuberculosis, and Respiratory Diseases with extensive years of clinical experience. He has a vast network of professional contacts in the medical field, an outstanding ability to provide healthcare with an emphasis on holistic approach, treating the patients as a physical, emotional, and social being, has an excellent bedside manner, and an admirable ability to establish rapport with the patient. He also has exceptional skills in imparting health related teachings for a complete and speedy recovery of his patients and has an incomparable critical thinking and analytical skills.

This doctor is not available for online consultations on the platform anymore.

Hello,

Welcome to icliniq.com.

Your father is suffering from acute exacerbation of COPD (chronic obstructive pulmonary disease) with CAP (community-acquired pneumonia) and sepsis. Currently, he is on appropriate antibiotics. But, he needs systemic steroids to cope with the exacerbation along with inhaled steroids. Though his X-ray (attachment removed to protect patient identity) appears normal, CT (computed tomography) thorax is suggestive of bilateral consolidation. Sputum culture should ideally tell us the exact bacteria and sensitive antibiotics for it. Supportive treatment like nutrition, supplemental oxygen, or noninvasive ventilation must be given.

There is no worry, as other vital organs are functioning normally. But he will take time to recover from this exacerbation. He also had tubercular effusion years back, but now it does not seem to be a relapse of TB (tuberculosis). So, no anti-TB medicines are required at present. Definitely, it is CAP with COPD exacerbation. Even after he gets well, he should take consultation from pulmonologist for inhaler treatment. A sputum culture report should be sought as soon as possible, or if it is not available, fiberoptic bronchoscopy can be performed to take endobronchial sampling for cultures. Steroids should be tapered in appropriate doses.

I hope this helps.

Thank you.

Medically reviewed by Dr. Sneha Kannan
Published At February 22, 2016
Reviewed At June 23, 2025

Education:

MBBS

Professional Bio:

Dr. Amol Kumar Wasudeorao Diwan is a qualified Specialist in Pulmonary Medicine, Tuberculosis, and Respiratory Diseases with extensive years of clinical experience. He has a vast network of professional contacts in the medical field, an outstanding ability to provide healthcare with an emphasis on holistic approach, treating the patients as a physical, emotional, and social being, has an excellent bedside manner, and an admirable ability to establish rapport with the patient. He also has exceptional skills in imparting health related teachings for a complete and speedy recovery of his patients and has an incomparable critical thinking and analytical skills.

This doctor is not available for online consultations on the platform anymore.

Education:

BDS

Professional Bio:

Dr. Sneha Kannan is a skilled Dental Surgeon with expertise in providing general dental care, including scaling, fillings, and preventive treatments. She does oral surgery procedures such as extractions and minor surgical interventions. She does procedures in restorative dentistry, including crowns, bridges, and dentures. She is an expert in doing endodontic treatments such as root canal therapy. She is well-versed in doing procedures in cosmetic dentistry, including teeth whitening and smile correction. She can provide pediatric dental care for children’s oral health and preventive treatments. She promotes oral hygiene awareness and preventive dental practices.  

This doctor is not available for online consultations on the platform anymore.

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Education:

MBBS

Professional Bio:

Dr. Amol Kumar Wasudeorao Diwan is a qualified Specialist in Pulmonary Medicine, Tuberculosis, and Respiratory Diseases with extensive years of clinical experience. He has a vast network of professional contacts in the medical field, an outstanding ability to provide healthcare with an emphasis on holistic approach, treating the patients as a physical, emotional, and social being, has an excellent bedside manner, and an admirable ability to establish rapport with the patient. He also has exceptional skills in imparting health related teachings for a complete and speedy recovery of his patients and has an incomparable critical thinking and analytical skills.

This doctor is not available for online consultations on the platform anymore.

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