65 female,chulha smoker,diagnosed sputum positive PTB in March,completed 6mthAKT till last month,with clinicoradiological improvement. this month follow up cxray showing reappearing of opacities as earlier.pt is having dry cough,grade 2 dyspnea.taking treatment for COPD.n o fever, apetite normal,gaining wt. what action to be taken next?

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As there is no fever so this pt should be taken as old healed with resultant sequeled bro chiectatic pic both lwr zn with asthamatic bronchotis again as a sequele Both these sequeles are common in post treatmrnt period

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As pt is gaining weight with good appetite with doe gr2 , we will manage online of AECB ,inhaled steroids with LABA , long-acting anticholinergic bronchodilator like triatropiun ,oral steroids with mucolytic and appropriate antibiotics preferably from quinolon group or amoxyclav clav ,and expectorants

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CH TOBACCO SMOKER COPD PTB RX 6 MONTHS REAPPEARANCE OF LESIONS MEANS INADEQUATE PERIOD OF TREATMENT . SPTUM FOR AFB & CULTURE FOR AFB TO BE DONE I F + VE ATD TO BE CONTINUED BLOOD SUGAR ,H IV ANTIBODY RX FOR COPD TO CONTINUE STEROID INHALER & STEROID P O TO BE AVOIDED

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

COPD with Bronchiactesis both lower lungs

To see real improvment one must do sputum AFB regularly rather than relying on clinico radiological appearances His HIV status must be tested. clinically speaking COPD will not appear so progressive as to demand quick intervention.Symptomatic trt will be sufficient.

Nine months treatment is necessary for koch lung avoid steroid without antibiotic cover . High protein diet is necessary advice fundoscopy if patient is on ethambutol give nerobion fort iron sos .

Go for sputum afb.and blood routine and blood sugar examination. If 3 sputum for a.f.b examination tests comes negative than treat her with a course of antibiotics with bronchodilators and steroids.

Repeat sputum for AFB/ tubercular immunology/ ACE/Montoux/ Lung Bx: think interms of Sarcoidosis.

AND TO STOP TOBACCO SMOKING

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