Nebulized budesonide in the treatment of exacerbations of chronic obstructive pulmonary disease: Efficacy, safety, and effects on the serum levels of soluble differentiation molecules

Makarova, E. V.; Gn, Varvarina; Nv, Menkov; My, Czapaeva; Es, L. Van; Za, Kazatskaya; Novikov, V. V.; Karaulov, Alexander

doi:10.17116/terarkh201688324-31

Cited by 3 publications

(15 citation statements)

References 27 publications

(22 reference statements)

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“…12 ICS also seems to have systemic effects in COPD exacerbations including on C-reactive protein, tissue necrosis factor alpha, serum cytokines, and adhesion molecules. [13][14][15] Corticosteroids have significant effects on ␤ 2 receptors in COPD, which affects subsensitivity that occurs with chronic high doses of ␤ 2 agonists or in the presence of a viral respiratory tract infection. 9 Therefore, by augmenting the effects of ␤ 2 agonists, the addition of ICS serves as a means to help optimize bronchodilation.…”

Section: Pharmacology Of Systemic Corticosteroids and Ics In The Treamentioning

confidence: 99%

Nebulized Corticosteroids in the Treatment of COPD Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

Pleasants

Wang

et al. 2018

Respir Care

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Based on our meta-analysis with a change in FEV as the primary end point, high-dose nebulized budesonide was an acceptable alternative to systemic corticosteroids in hospitalized subjects with COPD exacerbations who were not critically ill. Additional well-designed prospective studies are needed in both the acute care and ambulatory settings. We provide perspective on how this evidence might be applied in clinical practice.

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Section: Pharmacology Of Systemic Corticosteroids and Ics In The Treamentioning

confidence: 99%

Nebulized Corticosteroids in the Treatment of COPD Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

Pleasants

Wang

et al. 2018

Respir Care

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“…Concomitant asthma was explicitly excluded in most trials (n=14). Eight trials excluded participants with a smoking index <10 pack-years [ 53 , 54 , 58 ] or <20 pack-years [ 42 , 47 , 48 , 50 , 56 ]. We noted no significant baseline differences between treatment arms, apart from two trials [ 48 , 58 ] ( supplementary table A1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Eight trials excluded participants with a smoking index <10 pack-years [ 53 , 54 , 58 ] or <20 pack-years [ 42 , 47 , 48 , 50 , 56 ]. We noted no significant baseline differences between treatment arms, apart from two trials [ 48 , 58 ] ( supplementary table A1 ). Participants were followed-up for a median 10 days, with a range from 24 h [ 39 ] to 12 months [ 41 ].…”

Section: Resultsmentioning

confidence: 99%

“…Health-related quality of life showed similar improvement with both inhaled and systemic corticosteroids across six trials with 885 participants. These used the St George's Respiratory Questionnaire (SGRQ) [ 38 ], SGRQ-C [ 53 ], the COPD Assessment Test [ 41 , 48 ], the clinical COPD questionnaire (CCQ) [ 54 ] and modified Guyatt measure [ 59 ] to capture post-treatment scores. When pooling data with the SMD, we noted a balanced effect in both groups (SMD 0.0, 95% CI −0.16–0.16, I 2 =22%, moderate certainty).…”

Section: Resultsmentioning

confidence: 99%

“…Improvement in post-treatment scores was reportedly similar in the S tällberg et al [ 54 ] (109 participants, CCQ symptoms subscore) and D jordjevic et al [ 42 ] (60 participants, score not described) trials. Cough [ 48 , 54 ] and sputum [ 48 ] were scarcely reported, without any significant between-group difference.…”

Section: Resultsmentioning

confidence: 99%

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Inhaledversussystemic corticosteroids for acute exacerbations of COPD: a systematic review and meta-analysis

Papadopoulou,

Bin Safar,

Khalil

et al. 2024

Eur Respir Rev

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This meta-analysis compares the efficacy and safety of inhaledversussystemic corticosteroids for COPD exacerbations.Following a pre-registered protocol, we appraised eligible randomised controlled trials (RCTs) according to Cochrane methodology, performed random-effects meta-analyses for all outcomes prioritised in the European Respiratory Society COPD core outcome set and rated the certainty of evidence as per Grading of Recommendations Assessment, Development and Evaluation methodology.We included 20 RCTs totalling 2140 participants with moderate or severe exacerbations. All trials were at high risk of methodological bias. Low-certainty evidence did not reveal significant differences between inhaled and systemic corticosteroids for treatment failure rate (relative risk 1.75, 95% CI 0.76–4.02, n=569 participants); breathlessness (mean change: standardised mean difference (SMD) −0.11, 95% CI −0.36–0.15, n=239; post-treatment scores: SMD −0.18, 95% CI −0.41–0.05, n=293); serious adverse events (relative risk 1.47, 95% CI 0.56–3.88, n=246); or any other efficacy outcomes. Moderate-certainty evidence implied a tendency for fewer adverse events with inhaled compared to systemic corticosteroids (relative risk 0.80, 95% CI 0.64–1.0, n=480). Hyperglycaemia and oral fungal infections were observed more frequently with systemic and inhaled corticosteroids, respectively.Limited available evidence suggests potential noninferiority of inhaled to systemic corticosteroids in COPD exacerbations. Appropriately designed and powered RCTs are warranted to confirm these findings.

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Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease

Walters

Tan

White

et al. 2018

Cochrane Database of Systematic Reviews

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Information from a new large study has increased our confidence that five days of oral corticosteroids is likely to be sufficient for treatment of adults with acute exacerbations of COPD, and this review suggests that the likelihood is low that shorter courses of systemic corticosteroids (of around five days) lead to worse outcomes than are seen with longer (10 to 14 days) courses. We graded most available evidence as moderate in quality because of imprecision; further research may have an important impact on our confidence in the estimates of effect or may change the estimates. The studies in this review did not include people with mild or moderate COPD; further studies comparing short-duration systemic corticosteroid versus conventional longer-duration systemic corticosteroid for treatment of adults with acute exacerbations of COPD are required.

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Nebulized budesonide in the treatment of exacerbations of chronic obstructive pulmonary disease: Efficacy, safety, and effects on the serum levels of soluble differentiation molecules

Abstract: Nebulized budesonide is an effective and safe alternative to SGCS in treating an exacerbation of COPD. Inhaled GCSs, unlike SGCSs, exhibit anti-inflammatory activity, but exert no immunosuppressive activity.

Cited by 3 publications

References 27 publications

Nebulized Corticosteroids in the Treatment of COPD Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

Nebulized Corticosteroids in the Treatment of COPD Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

Inhaledversussystemic corticosteroids for acute exacerbations of COPD: a systematic review and meta-analysis

Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease

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