Case Study

Chronic Obstructive Pulmonary Disease (COPD) vs. Heart Failure (HF) vs. Bacterial Pneumonia (PNA): What is the Diagnosis This Time? 

Michael R. Broyles, PharmD – Director of Pharmacy and Lab Services

Age, sex:

 72-year-old male

Significant medical history:

COPD and congestive HF. The table below represents the same patient, admitted on six different occasions over a two-year period. 


*NT-proBNP values vary by manufacturer and are age dependent, thus the, +2, +3, etc. are times the normal values.

Key takeaways

In all six admissions, the patient presentation is very similar, making it challenging to determine the etiology of the symptoms. White blood counts (WBC) are not specific to bacterial infection. In these cases, the chest films showed similar non-specific findings which is not particularly helpful when differentiating viral infection vs. bacterial infection vs. heart failure. When there is a co-infection present in COPD and PNA, the etiology is viral approximately 50% of the time,1 where antibiotics are not warranted. In heart failure, up to 20% can have bacterial co-infections.2

In these scenarios, utilizing PCT in the differential diagnosis can lead to appropriate antibiotic treatment decisions for each separate admission.


AECOPD: acute exacerbation of chronic obstructive pulmonary disease
SOB: shortness of breath
WNL: within normal limits


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  1. Klein EY, Monteforte B, Gupta A, Jiang W, May L, Hsieh YH, et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza Other Respir Viruses. 2016 Sep;10(5):394-403.
  2. Triposkiadis F, Giamouzis G, Parissis J, Starling RC, Boudoulas H, Skoularigis J, et al. Reframing the association and significance of co-morbidities in heart failure. Eur J Heart Fail. 2016 Jul;18(7):744-58.