What is the cause of leukocytosis (White Blood Cell count of 11.3) in a patient with Chronic Obstructive Pulmonary Disease (COPD) and pulmonary nodules, with radiographic findings of limited lung expansion and moderate cardiomegaly?

From the Guidelines

The elevated white blood cell count (WBC) of 11.3 in this patient with COPD and lung nodules is likely due to an underlying inflammatory process, possibly an infection or exacerbation of their COPD, and should be managed with appropriate antibiotics, bronchodilators, and possibly corticosteroids, as recommended by the 2017 GOLD report 1. The patient's clinical presentation, including symptoms like fever, cough, sputum production, or shortness of breath, should be evaluated in the context of the elevated WBC.

• The limited inspiration on chest X-ray suggests the patient may not have been able to take a deep breath during imaging, which is common in COPD patients due to hyperinflation and air trapping.
• The moderate cardiomegaly (enlarged heart) and tortuous aorta are additional findings that may indicate cardiovascular comorbidities, which are common in COPD patients.
• The lung nodules require further evaluation with additional imaging such as a CT scan to determine their nature, as they could represent infection, inflammation, or potentially malignancy. Management should focus on treating any acute infection or COPD exacerbation with:
• Appropriate antibiotics (such as azithromycin 500mg on day 1, then 250mg daily for 4 days, or doxycycline 100mg twice daily for 5-7 days)
• Bronchodilators (like albuterol 2 puffs every 4-6 hours as needed)
• Possibly corticosteroids (prednisone 40mg daily for 5 days) if an exacerbation is present, as exacerbations can be associated with increased sputum production and, if purulent, increased bacteria may be found in the sputum 1. The elevated WBC should normalize with appropriate treatment of the underlying cause. It is also important to note that COPD exacerbations increase susceptibility to additional events 1, and patients with COPD susceptible to frequent exacerbations have worse health status and morbidity than patients with less-frequent exacerbations 1. Therefore, management should prioritize reducing the risk of future exacerbations and improving the patient's overall health status, as recommended by the 2018 GOLD report review 1.

From the Research

Patient's Condition

The patient has Chronic Obstructive Pulmonary Disease (COPD) with nodules in the lungs, and a chest X-ray shows limited inspiration achieved. The patient also has a moderately enlarged heart and a tortuous thoracic aorta.

White Blood Cell Count (WBC)

The patient's WBC count is 11.3, which is slightly elevated. This could be indicative of an infection or inflammation in the body.

COPD Exacerbations

Studies have shown that azithromycin can reduce the frequency of exacerbations in patients with COPD 2, 3, 4, 5. Azithromycin has anti-inflammatory properties and can help reduce the production of proinflammatory cytokines, which can contribute to COPD exacerbations 3.

Azithromycin Therapy

Long-term azithromycin therapy has been shown to be effective in reducing COPD exacerbations, especially in patients with frequent exacerbations 2, 3, 5. However, there are concerns about the potential risks of azithromycin therapy, such as hearing decrements and antibiotic resistance 2, 4.

Key Findings

• Azithromycin can reduce the frequency of COPD exacerbations 2, 3, 4, 5
• Azithromycin has anti-inflammatory properties and can help reduce the production of proinflammatory cytokines 3
• Long-term azithromycin therapy can be effective in reducing COPD exacerbations, especially in patients with frequent exacerbations 2, 3, 5
• There are concerns about the potential risks of azithromycin therapy, such as hearing decrements and antibiotic resistance 2, 4

Possible Causes of Elevated WBC

The elevated WBC count in the patient could be due to various factors, including:

• Infection or inflammation in the lungs or airways
• COPD exacerbation
• Other underlying medical conditions

It is essential to note that the provided studies do not directly address the patient's elevated WBC count. However, they do provide information on the potential benefits and risks of azithromycin therapy in patients with COPD, which may be relevant to the patient's condition. Further evaluation and testing would be necessary to determine the cause of the elevated WBC count and to develop an appropriate treatment plan.