Effect of Systemic Glucocorticoids on Exacerbations of Chronic Obstructive Pulmonary Disease

Niewoehner, Dennis E.; Erbland, Marcia L.; Deupree, Robert H.; Collins, Dorothea; Gross, Nicholas J.; Light, Richard W.; Anderson, Paula; Morgan, Nancy A.

doi:10.1056/nejm199906243402502

Cited by 766 publications

(497 citation statements)

References 19 publications

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“…Systemic glucocorticoids are frequently prescribed for exacerbations of the disease and have been shown to be effective in improving FEV1 [5], but even when given for exacerbations, the beneficial effects of systemic steroids appear to be limited to the first two weeks only [6].…”

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confidence: 99%

Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids

et al. 2001

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Systemic corticosteroids are often administered in COPD patients. The relationship between systemic glucocorticoids and mortality in patients with moderate to severe chronic obstructive pulmonary disease (COPD) was retrospectively analysed. Baseline characteristics of the patients, in stable clinical condition, were collected on admission to a pulmonary rehabilitation centre. Overall mortality was asessed at the end of follow-up. The Cox proportional hazards model was used to quantify the relationship between glucocorticoid use, distinguishing administration route (oral/inhalation) and oral dose, and overall mortality, adjusted for the influence of age, sex, smoking, lung function, resting arterial blood gases and body mass index.On multivariate analysis, oral glucocorticoid use at a (prednisone equivalent) dose of 10 mg . day -1 without inhaled glucocorticoids, was associated with an increased risk (RR~2.34, 95% confidence interval (CI) 1.24 -4.44) while 15 mg . day -1 carried a relative risk of 4.03, CI~1.99 -8.15). A significant interaction was observed between inhaled and oral glucocorticoid use. Combined with inhaled glucocorticoids, the relative risk of oral glucocorticoid use appeared to be significantly smaller.It is concluded that in severe chronic obstructive pulmonary disease, maintenance treatment with oral glucocorticoids is associated with increased mortality in a dosedependent manner. Since the present study design cannot exclude the possibility of bias by indication, further prospective studies are indicated using a broader patient characterization.

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confidence: 99%

Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids

et al. 2001

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“…Furthermore, corticosteroids can counteract bronchospasms, which can play a significant role in some cases of pneumonia (e.g. in patients with chronic obstructive pulmonary disease ⁄ asthma or virus-induced pneumonia) [29,30]. These potential beneficial effects of corticosteroids have been investigated in several clinical trials in which corticosteroids have been used as adjunctive therapy in patients with sepsis and septic shock as well as in those with pneumonia [28,[31][32][33][34][35][36].…”

Section: Corticosteroidsmentioning

confidence: 99%

Treatment with anti‐inflammatory drugs in community‐acquired pneumonia

Meijvis

Garde

Rijkers

et al. 2012

Journal of Internal Medicine

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“…A systematic review suggested that systemic steroids result in physiologic improvement over the first 72 hours and reduced the odds of a treatment failure over the subsequent 30 days, although the risk of adverse drug reaction was increased (101). The largest study evaluated 271 patients from 25 Veterans Affairs medical centers (102). Patients were randomized to placebo or one of two steroid treatment arms (Solumedrol 125 mg/d for 3 d followed by either a 15-d or 8-wk taper).…”

Section: Therapeutic Approaches Generalmentioning

confidence: 99%

Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Martínez

2007

Proceedings of the American Thoracic Society

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Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural history of this chronic lung disorder. These events can be caused by a large number of infectious and noninfectious agents and are associated with an increased local and systemic inflammatory response. Their frequency and severity have been linked to progressive deterioration in lung function and health status. Infectious pathogens ranging from viral to atypical and typical bacteria have been implicated in the majority of episodes. Most therapeutic regimens to date have emphasized broad, nonspecific approaches to bronchoconstriction and pulmonary inflammation. Increasingly, therapy that targets specific etiologic pathogens has been advocated. These include clinical and laboratory-based methods to identify bacterial infections. Further additional investigation has suggested specific pathogens within this broad class. As specific antiviral therapies become available, better diagnostic approaches to identify specific pathogens will be required. Furthermore, prophylactic therapy for at-risk individuals during high-risk times may become a standard therapeutic approach. As such, the future will likely include aggressive diagnostic algorithms based on the combination of clinical syndromes and rapid laboratory modalities to identify specific causative bacteria or viruses.

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Effect of Systemic Glucocorticoids on Exacerbations of Chronic Obstructive Pulmonary Disease

Cited by 766 publications

References 19 publications

Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids

Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids

Treatment with anti‐inflammatory drugs in community‐acquired pneumonia

Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

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