Take Home Points

1. Single dose oral dexamethasone is an excellent choice for asthma exacerbations. It takes away the compliance issue for patients who have trouble getting medications or filling medications once they leave the ED.
2. Antibiotics aren’t always indicated in COPD exacerbations, but are used much more frequently than in asthma exacerbations because the structural changes in the patient’s lung lead to increased bacterial colonization. In general, if the patient has increased cough or sputum production, they probably would benefit from a course of antibiotics
3. In general, azithro alone is no longer a good choice as solo covereage for community acquired pneumonia.  Adding either amoxicillin or cefdinir to you amoxicillin should get you good coverage of both strep pneumo and atypicals.