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*healthy with no recent antibiotics=macrolide or doxy *comorbidities or recent antibiotic=DRSP=resp quinolone OR beta-lactam + macrolide OR beta-lactam +Doxy Pneumonia length of treatment *minimum 5 days *average 5-10 days *re-evaluate after 48-72 hrs if poor response Pneumovax *PPSV: 19-64 with increased risk *PCV13 + PPSV23: all adults /= 65, or 19-64 with asplenia, immunocompromised, CSF leaks, cochlear implant, advanced CKD COPD persistent airflow limitation that is usually progressive and associated with enhanced chronic inflammatory response in the airways and lung to noxious particles or gases COPD Diagnosis *symptoms compatible with COPD (DOE, cough, sputum) *spirometry=FEV1/FVC ration 70% plus FEV1 80% predicted *no alternative explanation for symptoms *Alpha-1 antitrypsin deficiency COPD Stage 1 Mild: FEV1/FVC 70%, with or without symptoms COPD Stage 2