Evaluation of Corticosteroid Dose in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Hemenway, Alice N.; Terry, Alexandra M.

doi:10.1177/0018578717722540

Cited by 8 publications

(7 citation statements)

References 19 publications

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“…21 Compared to placebo, high-dose SCS with a duration > 5 d was associated with lower risk of treatment failure or relapse and improved FEV 1 ; however, this treatment significantly increased the incidence of hyperglycemia, which was demonstrated in a previous cohort study. 36 Medium-dose SCS improved FEV 1 versus placebo, but it did not show superiority in other outcomes. Interestingly, only low-dose SCS significantly shortened the hospital LOS versus placebo, which was consistent Total (95% CI) Total events Heterogeneity: Tau 2 = 0.59; Chi 2 = 6.35, df = 2 (P = .04); I 2 = 69% Test for overall effect: Z = 1.01 (P = .31)…”

Section: Discussionmentioning

confidence: 92%

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Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation

Liu

Feng

et al. 2020

Respir Care

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BACKGROUND: Although systemic corticosteroids (SCS) have long been used to treat patients with COPD exacerbation, the recommended dose remains controversial. We aimed to perform a meta-analysis and an indirect treatment comparison to investigate the efficacy and safety of different doses of SCS in subjects with COPD exacerbation. METHODS: Studies were identified by searching different databases for randomized controlled trials that investigated the efficacy and safety of SCS with placebo in subjects with exacerbation of COPD. The different doses of SCS were assigned to low-dose (ie, initial dose^40 mg prednisone equivalent/d [PE/d]), mediumdose (initial dose 5 40-100 mg PE/d, and high-dose (initial dose > 100 mg PE/d) groups. The indirect treatment comparison was performed between low-, medium-, and high-dose SCS groups. RESULTS: Twelve trials with 1,375 participates were included. Compared to placebo, the risk of treatment failure was lower in the low-dose SCS groups (risk ratio 0.61 [95% CI 0.43-0.88], P 5 .007) and high-dose SCS groups (risk ratio 0.64 [95% CI 0.48-0.85], P 5 .002); the FEV 1 was significantly improved in low-dose (mean difference 0.09 [95% CI 0.06-0.12], P < .001), medium-dose (mean difference 0.23 [95% CI 0.02-0.44], P 5 .036), and high-dose SCS groups (mean difference 0.09, [95% CI 0.03-0.15], P < .001, respectively). Regarding safety, the incidence of hyperglycemia was higher in high-dose SCS groups versus placebo (risk ratio 2.52 [95% CI 1.13-5.62], P 5 .02). The indirect comparison between low-, medium-, and high-dose SCS found that the risk of treatment failure and changes in FEV 1 were similar between these doses of SCS. CONCLUSIONS: This meta-analysis indicates that low-dose SCS (initial dose4 0 mg PE/d) was sufficient and safer for treating subjects with COPD exacerbation, and it was noninferior to higher doses of SCS (initial dose > 40 mg PE/d) in improving FEV 1 and reducing the risk of treatment failure. However, our findings need to be verified in head-to-head randomized controlled trials.

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Section: Discussionmentioning

confidence: 92%

“…The current meta-analysis results were also accordant with previous observational studies. [36][37][38] High-dose and long-term SCS should be used with caution due to the risk of hyperglycemia, and these regimens did not show superiority in improving lung function or prognosis compared with lower dose SCS.…”

Section: Scs > 5 Daysmentioning

confidence: 99%

Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation

Liu

Feng

et al. 2020

Respir Care

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“…19 In a single-center retrospective cohort study, 665 AECOPD patients were divided into three cumulative dose range groups (low: ≤250 mg prednisone equivalents, moderate: 251 to 500 mg, and high: ≥501 mg) and there were no statistically significant increases in length of hospital stay and readmission rates when the systemic corticosteroid doses increased, but the rate of impaired blood glucose levels obviously increased with SCS dose. 20 In addition, those studies mostly included patients with mild AECOPD, and data are lacking regarding moderate and severe AECOPD.…”

Section: Discussionmentioning

confidence: 99%

<p>Comparison of the Clinical Outcomes Between Nebulized and Systemic Corticosteroids in the Treatment of Acute Exacerbation of COPD in China (CONTAIN Study): A Post Hoc Analysis</p>

Chen

Liu

Zhang

et al. 2020

COPD

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Background and Objective: Although corticosteroids have been widely used in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), few studies have evaluated the effectiveness of nebulized corticosteroids (NCS), systemic corticosteroids (SCS), and NCS plus SCS in the management of AECOPD in China. This study aimed to evaluate the effectiveness of NCS, SCS, and NCS plus SCS in Chinese patients with AECOPD. Patients and Methods: This was a real-world study of AECOPD patients at 43 sites from January to September 2014. During hospitalization, patients treated with nebulized budesonide (NCS group, n=1091), SCS (SCS group, n=709), or both (NCS+SCS group, n=1846) were included. Propensity score matching (PSM) and subgroup analyses were performed. The primary outcomes were the length of hospital stay, mortality, and change in arterial blood gases from baseline. Results: Multivariable analysis showed that the three treatments at the same severity of AECOPD were not significantly different regarding intubation rates, rates of pneumonia improvement at discharge, rates of new-onset pneumonia in hospital, and mortality. Following PSM, NCS+SCS was associated with greater length of hospital stay than both NCS and SCS (in patients without respiratory failure [RF, P<0.001] and with type I RF [P=0.022]), and more hospitalization costs than the other two treatments (in patients without RF [P<0.001]). Conclusion: NCS is effective for patients with AECOPD, which may be an alternative treatment option. Further clinical trials are urgently needed to better understand the efficacy of NCS, SCS, and NCS+SCS in AECOPD management in China.

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“…7 The DECAF Score shows promise for the risk stratification of patients hospitalized with Acute exacerbation of COPD (AECOPD). 8 Studies in the past suggest DECAF score is a better predictor of mortality than CURB-65 (Confusion Urea nitrogen, Respiratory rate, Blood pressure, 65 years of age and older), COPD, and Asthma Physiology Score predictive tools. 9 The death rates for each grade of the DECAF Score suggest the following risk categories: DECAF 0-1 ('low risk'; inhospital mortality 1.4%); DECAF 2 ('moderate risk'; mortality 8.4%); and DECAF 3-6 ('high risk'; mortality 34.6%).…”

Section: Introductionmentioning

confidence: 99%

Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Lower and Higher Decaf Scores

Daud¹,

Ambreen²,

Shafique³

et al. 2022

JRMC

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Background: To determine diagnostic accuracy of DECAF score in predicting mortality in patients with acute exacerbation of chronic obstructive pulmonary disease having DECAF score <4 and within 7 days of hospital admission keeping actual mortality as gold standard. Methods: In this cross sectional validation study, 146 Patients with COPD were selected from emergency and OPD of Fauji Foundation Hospital Rawalpindi presenting with signs and symptoms of acute exacerbation of COPD from 15 may 2017-15 Nov. 2017.The procedure began after taking informed consent of the patients. Clinical features documented and investigations were sent. The expense of all the tests was borne by the hospital administration and not the patient. A specially designed Performa was used for data collection. RESULTS: Mean age (years) in the study is 64.90+0.93. Patients with DECAF score of 1, 2 and 3 are (2.7+26+35.6 =64.3) are 64 %. The cases with DECAF score of 4 are 26.7% and the cases with DECAF score of 5 and 6 are 8.9%. DECAF score versus mortality with different age groups and duration of smoking gave reasonably high values of sensitivity and, specificity. Also the PPV and NPV values are appropriate. The minimum diagnostic accuracy is 71.23% indicating that this test is appropriate in predicting the true status of the cases.CONCLUSION: The study concludes that DECAF score is a useful predictor of mortality in patients admitted with acute exacerbation of COPD. Patients admitted in hospital with high DECAF score of should be admitted in intensive care unit because they may require invasive ventilation due to respiratory failure and high mortality. KEYWORDS: Chronic obstructive pulmonary disease, acute ex

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Evaluation of Corticosteroid Dose in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Cited by 8 publications

References 19 publications

Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation

Efficacy and Safety of Different Doses of Systemic Corticosteroids in COPD Exacerbation

<p>Comparison of the Clinical Outcomes Between Nebulized and Systemic Corticosteroids in the Treatment of Acute Exacerbation of COPD in China (CONTAIN Study): A Post Hoc Analysis</p>

Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Lower and Higher Decaf Scores

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