Maranatha Daniel, Julian Parade Nur Nubli
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Airlangga University - Dr Soetomo General Hospital Surabaya, Indonesia.
Respir Med Case Rep. 2019 Sep 27;28:100936. doi: 10.1016/j.rmcr.2019.100936. eCollection 2019.
Eosinophilic chronic obstructive pulmonary disease (COPD) is a COPD phenotype with several clinical characteristics such as eosinophilic airway inflammation, more common in men and less severe COPD. Eosinophilic COPD has more exacerbations but responds well to corticosteroids and bronchodilators. We hereby report the case of a patient who came to us with shortness of breath, fever, wheezing and a cough with yellow phlegm. He had a history of smoking 4.5 pack-year and two episodes of pulmonary tuberculosis (the second was pulmonary multidrug-resistant tuberculosis). He was diagnosed with eosinophilic COPD exacerbation and pneumonia. Intravenous corticosteroids, bronchodilators and antibiotics were given and his condition improved after a week of hospitalisation. Smoking and pulmonary tuberculosis are risk factors for COPD. In this case, irreversible airflow obstruction is related to COPD and also pulmonary TB. There are several mechanisms that cause airway obstruction in pulmonary tuberculosis, one of which is persistent mycobacterium acting as a co-factor along with smoking and several environmental factors that cause chronic airway inflammation and result in bronchial narrowing with or without parenchymal destruction.
嗜酸性粒细胞性慢性阻塞性肺疾病（COPD）是一种具有多种临床特征的COPD表型，如嗜酸性粒细胞气道炎症，在男性中更常见且COPD病情较轻。嗜酸性粒细胞性COPD急性加重更频繁，但对皮质类固醇和支气管扩张剂反应良好。我们在此报告一例患者，该患者因呼吸急促、发热、喘息和咳黄痰前来就诊。他有4.5包年的吸烟史，并有两次肺结核病史（第二次为耐多药肺结核）。他被诊断为嗜酸性粒细胞性COPD急性加重并伴有肺炎。给予静脉注射皮质类固醇、支气管扩张剂和抗生素治疗，住院一周后病情好转。吸烟和肺结核是COPD的危险因素。在该病例中，不可逆气流受限与COPD有关，也与肺结核有关。肺结核导致气道阻塞有多种机制，其中之一是持续存在的分枝杆菌与吸烟及多种环境因素共同作用，引起慢性气道炎症，导致支气管狭窄，伴或不伴有肺实质破坏。
