Systemic Glucocorticoids in Severe Exacerbations of COPD

Sayıner, Abdullah; Aytemur, Zeynep Ayfer; Cirit, Murat; Ünsal, İpek

doi:10.1378/chest.119.3.726

Cited by 86 publications

(51 citation statements)

References 10 publications

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“…Notwithstanding these limitations, the results of our study actually challenge the findings of ALIA et al [21] and the explicit recommendations of systematic administration of systemic steroids in COPD exacerbation [4,11,21]. Regarding patients admitted to ICUs, most of these recommendations could be regarded as not fully supported as they rely on studies that explicitly excluded patients requiring ICU admission and ventilatory support [14,17,23,24].…”

Section: Discussioncontrasting

confidence: 49%

“…COPD exacerbations are usually associated with increases in local and systemic inflammatory response, and are treated with systemic steroids in accordance with high-grade recommendations [3,[11][12][13]. Indeed, although data are insufficient to define the optimal dose, route or duration of systemic corticosteroids, current guidelines strongly recommend administration of systemic steroids (prednisone equivalent doses of 30-40 mg?day -1 ) to hospitalised patients with AECOPD [1,14,15]. Recommendations rely on meta-analyses with cumulated effects showing both a significant reduction in the rate of treatment failure, and an increase in the rate of improvement in lung function and dyspnoea [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation

Abroug

Ouanes-Besbes

Fkih-Hassen³

et al. 2013

Eur Respir J

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Recommendation of the use of systemic steroids in chronic obstructive disease (COPD) exacerbation rely on trials that excluded patients requiring ventilatory support.In an open-label, randomised evaluation of oral prednisone administration, 217 patients with acute COPD exacerbation requiring ventilatory support were randomised (with stratification on the type of ventilation) to usual care (n5106) or to receive a daily dose of prednisone (1 mg?kg -1 ) for up to 10 days (n5111).There was no difference regarding the primary end-point, intensive care unit mortality, which was 17 (15.3%) deaths versus 15 (14%) deaths in the steroid-treated and control groups, respectively (relative risk 1.08, 95% CI 0.6-2.05). Analysis according to ventilation modalities showed similar mortality rates. Noninvasive ventilation failed in 15.7% and 12.7% (relative risk 1.25, 95% CI 0.56-2.8; p50.59), respectively. Both study groups had similar median mechanical ventilation duration and intensive care unit length of stay, which were 6 (interquartile range 6-12) days versus 6 (3.8-12) days and 9 (6-14) days versus 8 (6-14) days, respectively. Hyperglycaemic episodes requiring initiation or alteration of current insulin doses occurred in 55 (49.5%) patients versus 35 (33%) patients in the prednisone and control groups, respectively (relative risk 1.5, 95% CI 1.08-2.08; p50.015).Prednisone did not improve intensive care unit mortality or patient-centred outcomes in the selected subgroup of COPD patients with severe exacerbation but significantly increased the risk of hyperglycaemia. @ERSpublications In COPD exacerbation needing ventilatory support, prednisone has no impact on ICU mortality or related patient outcome

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Section: Discussioncontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation

Abroug

Ouanes-Besbes

Fkih-Hassen³

et al. 2013

Eur Respir J

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“…The exact dose and duration of therapy should be individualized and more specific recommendations must await further evidence. It appears that 10 days of therapy is more effective than three days, but no other comparisons have been made (198). We recommend treatment for periods of five to 14 days (Level III evidence).…”

Section: Corticosteroid Therapymentioning

confidence: 99%

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Balter

Forge

Low

et al. 2003

Canadian Respiratory Journal

116

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Acute exacerbations of chronic bronchitis (AECB) account for over 1.5 million physician visits annually in Canada and are a cause of significant morbidity and mortality. This document represents a joint effort between respirologists, microbiologists, infectious disease specialists and family physicians to update the Canadian AECB guidelines published in 1994. Treatment recommendations are graded on the strength of evidence in the published literature where possible. The role for oral corticosteroid therapy in preventing treatment failures, speeding up recovery and delaying the time to next exacerbation is discussed. Risk factors for treatment failure were used to stratify patients into risk groups to help guide antibiotic treatment recommendations. The importance of emerging antimicrobial resistance to current antibiotics is reviewed and strategies to prevent future AECB episodes are suggested.

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“…However, further evidence is required before recommending an exact dose and duration for these steroids. It appears that 10 days of therapy is more effective than three days, but no other comparisons have been made (70). We recommend treatment for periods of five to 14 days (level III evidence).…”

Section: Corticosteroid Therapymentioning

confidence: 98%

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis: Executive Summary

Balter

Forge

Low

et al. 2003

Canadian Respiratory Journal

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Systemic Glucocorticoids in Severe Exacerbations of COPD

Cited by 86 publications

References 10 publications

Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation

Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis: Executive Summary

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