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

Walters, Julia; Tan, Daniel J; White, Clinton J; Wood‐Baker, Richard

doi:10.1002/14651858.cd006897.pub4

Cited by 67 publications

(79 citation statements)

References 71 publications

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“…We reported interesting results for association between corticosteroids and early readmission in AECOPD patients, by showing that corticosteroid use for more than 5 days was associated with an increased risk of rehospitalisation. Our results correspond to recent meta-analysis results and recommendations that long-term corticosteroid use during hospitalisation has no benefit compared with short-term use [27]. This is the first study to report on the status and related predictors of AECOPD rehospitalisation using a nationwide healthcare database in Korea.…”

Section: Discussionsupporting

confidence: 89%

Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease

Rhee

Kim

et al. 2020

Preprint

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BackgroundPatients discharged after treatment for acute exacerbation of chronic obstructive pulmonary disease (COPD) are at high risk for readmission. We aimed to identify the prevalence and risk factors for readmission. MethodsWe included 16,105 patients who had claimed their medical expenses from May 1, 2014, to May 1, 2016 after discharge from any medical facility in Korea, following treatment for acute exacerbation of COPD. We analysed the potential risk factors for readmission within 30 days of discharge. ResultsReadmission rate was 26.4% (3989 patients among 15,101 patients) and over 50% of readmissions occurred within 10 days of discharge. Approximately 57% of readmissions occurred due to respiratory causes. Major causes of readmission were COPD (27%), pneumonia (14.2%) and lung cancer (7.1%), in that order. Patients who were readmitted were male, had more comorbidities, and were less frequently admitted to tertiary hospitals than those who were not readmitted. Risk factors for readmission within 30 days of discharge were male sex, medical aid coverage, longer hospital stay, longer duration of systemic steroid use during hospital stay, high comorbid condition index, and discharge to skilled nursing facility. ConclusionsReadmission occurred in approximately a quarter of patients, and was associated with patient-related and clinical factors. Using these results, we can identify high-risk patients for readmission and precautions are needed to be taken before deciding discharge plan. Further research is needed to develop accurate tools for predicting the risk of readmission before discharge and development and evaluation of an effective care programs for COPD patients are necessary.

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Section: Discussionsupporting

confidence: 89%

Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease

Rhee

Kim

et al. 2020

Preprint

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“…The Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial showed that a 5‐day course of oral corticosteroids was not inferior to a 14‐day course in terms of exacerbation recurrence but with a shorter length of hospital stay . A Cochrane review suggested that a short course, 3 to 7 days, of systemic corticosteroids does not lead to increase in treatment failure or risk of relapse of AECOPD. Data regarding the use of systemic corticosteroids are limited in the Asia‐Pacific region.…”

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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“…50 mg sollten nicht überschritten werden. Eine neuere Untersuchung belegt zusammen mit einer Metaanalyse die Wirksamkeit bei einer Therapiedauer von 5 Tagen [372,373]. Allerdings muss individuell entschieden werden, ob diese Therapiedauer im Einzelfall ausreichend ist.…”

Section: Definitionunclassified

Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD)

et al. 2018

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This document is a revision of the guideline for diagnosis and treatment of COPD that replaces the version from 2007. A multitude of recent reports regarding risk factors, diagnosis, assessment, prevention and pharmacological as well as non-pharmacological treatment options made a major revision mandatory. The new guideline is based on the GOLD document taking into account specifics in Germany and Austria.

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

Cited by 67 publications

References 71 publications

Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease

Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease

Acute exacerbation of COPD

Leitlinie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD)

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