Pneumonia and chronic obstructive pulmonary disease. What special considerations does this combination require?

Patients with chronic obstructive pulmonary disease are at increased risk for both community- and hospital-acquired pneumonia, most often through aspiration. Community-acquired pneumonia often manifests with acute onset of chills, fever, cough, and pleuritic chest pain. Atypical pneumonia syndromes are characterized by subacute onset over several days and constitutional complaints. Hospital-acquired pneumonia may be contracted during altered consciousness or after intubation, ventilation, or exposure to pathogens. Knowledge of the disease process and the means to accurately diagnose these infections allows physicians to prescribe effective antibiotic therapy. Stable patients may receive oral therapy, but with severe or hospital-acquired pneumonia, parenteral therapy is required. Combinations of agents may be needed to cover the variety of pathogens that may be present.