Comparison of two systemic steroid regimens for the treatment of COPD exacerbations

Ceviker, Yelda; Sayıner, Abdullah

doi:10.1016/j.pupt.2013.03.004

Cited by 29 publications

(21 citation statements)

References 13 publications

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“…We did not identify any systematic reviews comparing intravenous corticosteroids with oral corticosteroids in hospitalised patients with COPD exacerbations. Our own systematic review identified two trials in a total of 250 patients hospitalised with a COPD exacerbation [33,34]. One trial randomly assigned 210 hospitalised patients with COPD exacerbations to receive either 60 mg of intravenous prednisolone plus oral placebo or 60 mg of oral prednisolone plus intravenous placebo for 5 days [33].…”

Section: Values and Preferencesmentioning

confidence: 99%

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

et al. 2017

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This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.

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Section: Values and Preferencesmentioning

confidence: 99%

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

et al. 2017

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“…Data regarding the use of systemic corticosteroids are limited in the Asia‐Pacific region. A Turkish study comparing efficacy between oral steroid and intravenous methylprednisolone found that the improvement of blood gas parameters, symptom scores, length of stay and readmission due to AECOPD were comparable with these two treatments. However, the group receiving intravenous methylprednisolone had more events of recurrent AECOPD requiring attendance to emergency department, hyperglycaemia and worsened blood pressure control .…”

Section: Management Of Acute Exacerbations Of Copdmentioning

confidence: 99%

Acute exacerbation of COPD

et al. 2016

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The literature of acute exacerbation of chronic obstructive pulmonary disease (COPD) is fast expanding. This review focuses on several aspects of acute exacerbation of COPD (AECOPD) including epidemiology, diagnosis and management. COPD poses a major health and economic burden in the Asia-Pacific region, as it does worldwide. Triggering factors of AECOPD include infectious (bacteria and viruses) and environmental (air pollution and meteorological effect) factors. Disruption in the dynamic balance between the 'pathogens' (viral and bacterial) and the normal bacterial communities that constitute the lung microbiome likely contributes to the risk of exacerbations. The diagnostic approach to AECOPD varies based on the clinical setting and severity of the exacerbation. After history and examination, a number of investigations may be useful, including oximetry, sputum culture, chest X-ray and blood tests for inflammatory markers. Arterial blood gases should be considered in severe exacerbations, to characterize respiratory failure. Depending on the severity, the acute management of AECOPD involves use of bronchodilators, steroids, antibiotics, oxygen and noninvasive ventilation. Hospitalization may be required, for severe exacerbations. Nonpharmacological interventions including disease-specific self-management, pulmonary rehabilitation, early medical follow-up, home visits by respiratory health workers, integrated programmes and telehealth-assisted hospital at home have been studied during hospitalization and shortly after discharge in patients who have had a recent AECOPD. Pharmacological approaches to reducing risk of future exacerbations include long-acting bronchodilators, inhaled steroids, mucolytics, vaccinations and long-term macrolides. Further studies are needed to assess the cost-effectiveness of these interventions in preventing COPD exacerbations.

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“…It was found that the 5-day regimen was not inferior to the 14-day treatment with regard to a reexacerbation within 6 months of follow-up. Investigations have now indicated that lowering steroid doses may be appropriate and beneficial in the treatment of COPD [87,88]. This suggests that the current standard of care could be effectively altered to reduce the duration and dose of treatment, thereby diminishing the potential for therapeutic side effects (e.g.…”

Section: The Role Of Corticosteroid Therapy In Diabetes Onset and Promentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

et al. 2015

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The objective of this systematic review was to discuss our current understanding of the complex relationship between chronic obstructive pulmonary disease (COPD) and type-2 diabetes mellitus (T2DM). We performed a systematic search of the literature related to both COPD and diabetes using PubMed. Relevant data connecting both diseases were compiled and discussed. Recent evidence suggests that diabetes can worsen the progression and prognosis of COPD; this may result from the direct effects of hyperglycemia on lung physiology, inflammation or susceptibility to bacterial infection. Conversely, it has also been suggested that COPD increases the risk of developing T2DM as a consequence of inflammatory processes and/or therapeutic side effects related to the use of high-dose corticosteroids. In conclusion, although there is evidence to support a connection between COPD and diabetes, additional research is needed to better understand these relationships and their possible implications.

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Comparison of two systemic steroid regimens for the treatment of COPD exacerbations

Cited by 29 publications

References 13 publications

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

Acute exacerbation of COPD

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

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