Successful Treatment of Acute COPD Exacerbation with Pneumonia and Acute Respiratory Failure

Chief Complaints

A 71-year-old male patient with a body mass index (BMI) of 16 presented to the Pulmonology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of high-grade fever, shortness of breath on exertion, and cough for six days. The fever was associated with chills and rigors. He also reported burning urination, abdominal pain, nausea, and generalised body pain.

On further evaluation, the patient reported recurrent episodes of breathlessness for the past five years. The breathlessness was initially classified as Modified Medical Research Council (mMRC) Grade 2–3 and later progressed to Grade 4, with associated wheezing and worsening while lying down. He also had an occasional cough, which was initially dry and later became associated with thick, yellow-coloured sputum.

The patient had a smoking history of approximately 30 years and had stopped smoking five years earlier. He had a history of COVID-19 infection in the past, for which he received treatment at home. He had also received two doses of the COVID-19 vaccine. A long-standing history of recurrent skin rashes with hyperpigmentation was also noted. There was no history of regular treatment for the previously suspected chronic respiratory condition.

On examination, the patient was conscious, coherent, and oriented. He had significant breathing difficulty, wheezing, and cough. At the time of admission, his oxygen saturation was maintained at a stable level with two litres of supplemental oxygen. Respiratory examination findings were consistent with an acute lower respiratory infection and worsening of underlying chronic obstructive pulmonary disease. Neurological examination revealed difficulty with balance and coordination, suggestive of ataxia. Further neurological assessment was advised to identify the underlying cause.

Upon admission to PACE Hospitals, following a detailed clinical assessment, the Pulmonology team evaluated the patient for high-grade fever, worsening shortness of breath, cough with expectoration, wheezing, and reduced respiratory function.

Computed tomography of the chest revealed a few subcentimetric nodules and patchy ground-glass opacities in the right lung, suggestive of an infective or viral process. Paraseptal emphysematous changes with multiple pulmonary bullae were noted in both lungs. Cicatricial atelectatic changes were also present in the anterior segments of both upper lobes and the right middle lobe, along with mediastinal lymphadenopathy, with calcification in a few lymph nodes.

Based on the patient’s symptoms, clinical findings, and chest CT evaluation, he was diagnosed with right-sided pneumonia, acute exacerbation of Chronic Obstructive Pulmonary Disease, and acute respiratory failure. A nerve conduction study was also performed for balance and coordination difficulties, which showed sensory and motor axonal neuropathy associated with ataxia.

Routine investigations, including complete blood picture, blood and urine cultures, liver and renal function tests, glycated haemoglobin, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody profile, and influenza polymerase chain reaction testing, were performed to assess the patient’s overall condition and guide further management.

Based on the confirmed diagnosis, the patient was advised to undergo Acute exacerbation of COPD with pneumonia treatment in Hyderabad, India, along with respiratory failure under the expert care of the Pulmonology Department, with continued monitoring of oxygen levels and neurological symptoms.

After a detailed consultation by Dr. Pradeep Kiran Panchadi, (Consultant Interventional Pulmonologist), along with Dr. Manasa Gaddam, (Consultant Anesthetist), and Dr S Pramod Kumar (Consultant Neurophysician), the patient was diagnosed with acute exacerbation of COPD associated with right-sided pneumonia and acute respiratory failure.

Considering the acute respiratory infection, worsening breathing difficulty, productive cough, wheezing, underlying emphysematous lung changes, pulmonary bullae, and oxygen requirement, comprehensive medical management was identified as the most appropriate treatment.

It was determined that infection-control therapy, anti-inflammatory treatment, nebulisation, oxygen support, airway-opening therapy, mucus clearance, hydration, nutritional support, and close multidisciplinary monitoring were required to stabilise the patient and improve respiratory function.

The patient also required neurological evaluation and supportive management for ataxia secondary to sensory and motor axonal neuropathy.

The patient and his family members were counselled regarding the nature of COPD, the cause of the acute worsening of symptoms, the importance of avoiding smoking and respiratory irritants, correct use of nebulisation and oxygen support, regular oxygen saturation monitoring, breathing exercises, and the need for follow-up with a pulmonologist.

Following the decision, the patient underwent treatment for acute exacerbation of COPD, right-sided pneumonia, acute respiratory failure, and ataxia secondary to sensory and motor axonal neuropathy in Hyderabad at PACE Hospitals, under the expert supervision of the Pulmonology team.

During his hospital stay, the patient received intravenous therapy for controlling bacterial and viral infection, reducing airway inflammation, and relieving breathing difficulty.

Nebulisation therapy, oxygen support, mucus-thinning treatment, expectorant therapy, hydration, nutritional support, and other supportive measures were provided.

The patient was closely monitored for oxygen saturation, respiratory status, fever, sputum production, neurological symptoms, and haemodynamic stability.

Incentive spirometry and breathing exercises were also advised to support lung expansion and improve respiratory function.

At discharge, the patient was advised to continue medications for controlling respiratory infection, reducing airway inflammation, relieving allergy-related symptoms, thinning and clearing mucus, preventing blood clot formation, protecting the stomach lining, maintaining regular bowel movements, and supporting nutritional requirements.

Nebulization therapy and oxygen support were advised as required. These treatments were prescribed to maintain respiratory stability, reduce the risk of worsening breathlessness, and support recovery at home.

The patient was advised to take all prescribed medications and nebulisation therapy regularly and to use home oxygen whenever breathlessness developed, as directed by the pulmonologist. Regular monitoring of oxygen saturation and heart rate, adequate hydration, and a high-protein diet were recommended. He was also instructed to avoid dust, smoke, and flour mill exposure and to continue incentive spirometry and breathing exercises.

The patient was informed to contact the emergency ward at PACE Hospitals in case of high-grade fever, increasing breathlessness, reduced oxygen saturation, chest discomfort, confusion, bluish discoloration of the lips or fingers, severe wheezing, or any other alarming symptoms.

The patient was advised to return for a follow-up consultation with a Pulmonologist in Hyderabad at PACE Hospitals after five days.

This case highlights the successful management of acute exacerbation of COPD complicated by right-sided pneumonia, acute respiratory failure, and sensory-motor neuropathy with ataxia. Timely treatment for infection control, airway inflammation, breathing difficulty, and oxygen support led to improvement in fever, cough, breathlessness, and oxygen levels. The patient was discharged in a stable condition with breathing exercises, oxygen monitoring, home-care advice, and pulmonology follow-up.