CHEST
Clinical InvestigationsSystemic Glucocorticoids in Severe Exacerbations of COPD
Section snippets
Study Population
The study was conducted at a single, tertiary-care center. Thirty-six COPD patients, all current or ex-smokers with a smokinghistory ≥ 20 pack-years and severe airway obstruction(FEV1 < 35% predicted), and who presented with an exacerbation necessitating hospitalization, were included in thestudy. The criteria for admission to the hospital were the presence of severe dyspnea preventing the patient from performing even minoractivities (getting dressed or eating) and resulting in
Results
A total of 198 potential patients who were hospitalized in thechest department of a tertiary-care center were screened for the study. Of these, 36 patients were found to be eligible, were included in thestudy, and were randomized into the two groups. The main reasons forexclusion were prior use of steroids (n = 45), patients'unwillingness to participate (n = 42), presence of decompensated leftheart failure and/or uncontrolled hypertension (n = 37), need formechanical ventilation (n = 29), and
Discussion
This study was designed as a randomized, parallel-group, single-blind study comparing the effects of 3 days and 10 days of treatment with systemic corticosteroids in severe exacerbations of COPD. It did not include a control group with out any steroid treatment, as five controlled studies had already showed that these drugs weresuperior to placebo treatment, resulting in fewer treatment failures, shorter hospital stays, and faster improvement inFEV1 levels.12345 Each of these fivestudies used
ACKNOWLEDGMENT
We thank Hatice Ustün and Timur Kösefor their help with the statistical analyses.
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Cited by (85)
COPD and eosinophils
2022, Revue des Maladies RespiratoiresShort-term versus longer duration of glucocorticoid therapy for exacerbations of chronic obstructive pulmonary disease
2016, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :But they aimed at eliminating all possible confounding factors so that any potential difference in outcome could be attributed to the different glucocorticoid treatment regimes [8]. In Sayıner trial, it showed glucocorticoid treatment together with the optimal bronchodilator therapy resulted in more marked improvements in PaO2, FVC, and FEV1 levels in COPD patients who were administered systemic steroids for 10 days as compared to 3 days [9]. In TORCH trial, inhaled longacting beta-agonists combined with inhaled glucocorticoids reduce exacerbation rate, improve health status, and preserve lung function [28].
Blood eosinophils and treatment response in hospitalized exacerbations of chronic obstructive pulmonary disease: A case-control study
2016, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :AE-COPD exacerbations are usually associated with the activation of local and systemic inflammatory responses. Although the optimal dose, route or duration of therapy are undefined, current guidelines strongly recommend administration of systemic corticosteroids to hospitalized patients with AE-COPD [23–26]. These recommendations rely on meta-analyses demonstrating favourable outcomes both in terms of reduction of treatment failure and improvement of lung function parameters and dyspnea scores [27,28].
Comparison of two systemic steroid regimens for the treatment of COPD exacerbations
2014, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :Although systemic corticosteroids are universally used in the treatment of moderate-to-severe COPD exacerbations, very little data exists regarding the optimal regimen. Two previous studies have shown that the optimal treatment duration is 10–14 days and that longer treatments do not produce any better clinical results [9,13]. One other study compared the clinical effectiveness and safety of oral versus parenteral administration and found similar improvements in clinical outcomes [11].
Current drug treatment, chronic and acute
2014, Clinics in Chest Medicine