Systemic Corticosteroid and Antibiotic Use in Hospitalized Patients With Chronic Obstructive Pulmonary Disease Exacerbation

Petite, Sarah E.; Murphy, Julie A.

doi:10.1177/1060028018799696

Cited by 14 publications

(16 citation statements)

References 17 publications

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“…Systemic corticosteroids may improve the prognosis of these patients, hence decrease their risks of readmission. Several studies have shown that the use of systemic corticosteroid therapy can improve air ow limitations and lung function, reduce the likelihood of treatment failure, decrease the risk of relapse, and decrease the length of hospital stay [15][16][17][18], which is in accordance to the results above.…”

Section: Discussionsupporting

confidence: 84%

Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

Dai

Liang²,

2020

Preprint

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Objective To analyze acute exacerbation of chronic obstructive pulmonary disease(AECOPD) readmission events and to determine whether neutrophil-to-lymphocyte ratio(NLR) and bilirubin level are associated with readmission after discharge due to AECOPD .Methods A total of 170 patients with AECOPD were included. Patients were stratified into the readmission group if patients have two or more readmission within 2 years of the previous discharge and non-readmission group with one readmission or none within 2 years of the last discharge. Basic characteristics, laboratory examinations and clinical data of them were collected retrospectively and compared between these two groups. Then the patients were separated by the cutoffs of NLR and bilirubin level. The number of all-cause readmission within 2 years, time to first COPD-related readmission, 1-year and 2-year COPD-related readmission, 1-year and 2-year all-cause mortality were compared between groups respectively .Results Compared with readmission group, patients of non-readmission group had shorter length of hospital stay(P=0.034), more systemic corticosteroids use(P=0.007), higher NLR(P=0.001), higher bilirubin levels(P=0.010) and lower eosinophils counts(P=0.001). NLR and bilirubin level at admission can significantly influence the number of all-cause readmission(p=0.002, P<0.001, respectively). Lower bilirubin was associated with an increased risk of 1-year COPD-related readmission(OR 5.063, 95%CI 1.091-23.498) and 2-year COPD-related readmission(OR 4.699, 95% CI 1.269-17.396) .Conclusion For patients with AECOPD, longer hospital stay and less use of systemic corticosteroids may be associated with higher risk of readmission. NLR and bilirubin level at admission may be related to the number of all-cause readmission. Bilirubin can be regarded as a biomarker to predict readmission rates within 2 years after discharged throughout the course of disease.

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Section: Discussionsupporting

confidence: 84%

Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

Dai

Liang²,

2020

Preprint

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“…Other researchers [75] positively used blood eosinophil levels for predicting response to glucocorticoid treatment and the risk of severe acute exacerbations of COPD patients. Recently, Petite et al [76] evaluated the hospital length of stay (LOS) in hospitalized COPD patients with exacerbations treated with systemic corticosteroid and antibiotic therapy. They assessed that hospital LOS was shorter for patients prescribed standard-dose systemic corticosteroids and who use guideline-recommended systemic corticosteroid and antibiotic therapy is recommended for hospitalized patients with COPD exacerbation.…”

Section: The Role Of Eosinophilsmentioning

confidence: 99%

Influence of the Lung Microbiota Dysbiosis in Chronic Obstructive Pulmonary Disease Exacerbations: The Controversial Use of Corticosteroid and Antibiotic Treatments and the Role of Eosinophils as a Disease Marker

Toraldo¹,

Conte

2019

J Clin Med Res

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Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease associated with loss of lung function, poorer quality of life, co-morbidities, significant mortality, and higher health care costs. Frequent acute exacerbations of COPD are sudden worsening of symptoms, the nature of which is associated with bacterial or viral infections. However, one-third of exacerbations remain of undetermined origin. Although it is largely discussed and controversial, current guidelines recommend treatment of exacerbations with bronchodilators, antibiotics, and systemic corticosteroids; this is despite being associated with limited benefits in term of reducing mortality, side effects and without paying attention to the heterogeneity of these exacerbations. Increasing evidence suggests that the lung microbiota plays an important role in COPD and numerous studies have reported differences in the microbiota between healthy and disease states, as well as between exacerbations and stable COPD, leading to the hypothesis that frequent acute exacerbation is more likely to experience significant changes in lung microbiota composition. These findings will need further examination to explain the causes of lung dysbiosis, namely microbial composition, the host response, including the recruitment of eosinophils, lifestyle, diet, cigarette smoking and the use of antibiotics and corticosteroids. It is now important to assess: 1) Whether alterations in the lung microbiota contribute to disease pathogenesis, especially in exacerbations of unknown origin; 2) The role of eosinophils; and 3) Whether the microbiota of the lung can be manipulated therapeutically to improve COPD exacerbation event and disease progression. In summary, we hypothesize that the alterations of the lung microbiota may explain the undetermined origins of exacerbations and that there is an urgent need to facilitate the design of intervention studies that aim at conserving the lung microbial flora.

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“…Se realizaron otros dos estudios de cohortes entre pacientes [17, 18]. La iniciativa PharmLines presentó una oportunidad única de recuperar más información sobre muchos factores de confusión previamente no medidos.…”

Section: Transferencia En La Práctica De Dr Moisés Acuña-kaldman (Her...unclassified

Exacerbaciones agudas de la EPOC: Efectos del tratamiento antibiótico

Acuña-Kaldman¹

2022

Kompass Neumol

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Background: Although antibiotic treatment is recommended for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), its value in real-world settings is still controversial. Objectives: This study aimed to evaluate the short- and long-term effects of antibiotic treatment on AECOPD outpatients. Methods: A cohort study was conducted under the PharmLines Initiative. We included participants with a first recorded diagnosis of COPD who received systemic glucocorticoid treatment for an AECOPD episode. The exposed and reference groups were defined based on any antibiotic prescription during the AECOPD treatment. The short-term outcome was AECOPD treatment failure within 14–30 days after the index date. The long-term outcome was time to the next exacerbation. Adjustment for confounding was made using propensity scores. Results: Of the 1,105 AECOPD patients, antibiotics were prescribed to 518 patients (46.9%) while 587 patients (53.1%) received no antibiotics. The overall antibiotic use was associated with a relative risk reduction of AECOPD treatment failure by 37% compared with the reference group (adjusted odds ratio [aOR] 0.63 [95% CI: 0.40–0.99]). Protective effects were similar for doxycycline, macrolides, and co-amoxiclav, although only the effect of doxycycline was statistically significant (aOR 0.53 [95% CI: 0.28–0.99]). No protective effect was seen for amoxicillin (aOR 1.49 [95% CI: 0.78–2.84]). The risk of and time to the next exacerbation was similar for both groups. Conclusion: Overall, antibiotic treatment, notably with doxycycline, supplementing systemic glucocorticoids reduces short-term AECOPD treatment failure in real-world outpatient settings. No long-term beneficial effects of antibiotic treatment on AECOPD were found for the prevention of subsequent exacerbations.

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Systemic Corticosteroid and Antibiotic Use in Hospitalized Patients With Chronic Obstructive Pulmonary Disease Exacerbation

Cited by 14 publications

References 17 publications

Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

Predictive Value of NLR and Bilirubin Levels in the Readmission of AECOPD

Influence of the Lung Microbiota Dysbiosis in Chronic Obstructive Pulmonary Disease Exacerbations: The Controversial Use of Corticosteroid and Antibiotic Treatments and the Role of Eosinophils as a Disease Marker

Exacerbaciones agudas de la EPOC: Efectos del tratamiento antibiótico

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