Efficacy of different regimens of steroid therapy in patients with exacerbation of chronic obstructive pulmonary disease

Abstract

Exacerbation of chronic obstructive pulmonary disease (COPD) negatively influences on mortality, health related quality of life and lung function decline. Systemic corticosteroids are used to treat acute exacerbations of COPD. Aim. This randomized parallel group study was performed to eval uate short term efficacy and safety of nebulized budesonide (n = 40) and budesonide via a dry powder inhaler (DPI) (n = 40) compared with intra venous (IV) prednisolone (n = 40) in patients with acute non severe COPD exacerbations requiring hospitalization. Methods. The efficacy of treat ment was assessed from the study entry to the Day 10. Clinical improvement was assessed according to an improvement in FEV1, FVC, FEV / FVC, Borg scale, 6 minute walking test (6 MWT), SGRQ C and occurrence of adverse events. Results. Systemic prednisolone, budesonide DPI and neb ulized budesonide improved lung function in patients with acute exacerbation of COPD. Inhaled corticosteroids did not demonstrate systemic activ ity compared to systemic prednisolone. Conclusion. Our study suggests that nebulized budesonide and high dose budesonide DPI could be an alter native treatment to systemic steroids in patients with acute non severe exacerbation of COPD.

Inhaledversussystemic corticosteroids for acute exacerbations of COPD: a systematic review and meta-analysis

“…Concomitant asthma was explicitly excluded in most trials (n=14). Eight trials excluded participants with a smoking index <10 pack-years [ 53 , 54 , 58 ] or <20 pack-years [ 42 , 47 , 48 , 50 , 56 ]. We noted no significant baseline differences between treatment arms, apart from two trials [ 48 , 58 ] ( supplementary table A1 ).…”

“…Duration of exacerbation symptoms prior to enrolment was generally not specified, apart from three trials [ 47 , 50 , 64 ] with a mean duration ranging between 2.4 and 11 days. Four trials set an upper limit of 24 h [ 53 ], 7 days [ 43 , 54 ] or 14 days [ 50 ] of symptoms. Exacerbations were not specifically eosinophilic, but rather unselected; one trial [ 56 ] recruited exclusively patients with infective bacterial exacerbation.…”

“…Corticosteroids were administered for a median of 7 days, ranging from 1 to 15 days ( table 1 ). The inhaled corticosteroids arms received budesonide mostly via a nebuliser (n=17 trials, median dose 8 mg·day −1 , range 1.5–8 mg·day −1 ) or via inhaler devices (n=2, dose 800–1280 μg·day −1 ), but one trial used both in different arms [ 53 ]. Two other trials [ 45 , 50 ] initially administered corticosteroids via a nebuliser, and afterwards via an inhaler device.…”

“…Health-related quality of life showed similar improvement with both inhaled and systemic corticosteroids across six trials with 885 participants. These used the St George's Respiratory Questionnaire (SGRQ) [ 38 ], SGRQ-C [ 53 ], the COPD Assessment Test [ 41 , 48 ], the clinical COPD questionnaire (CCQ) [ 54 ] and modified Guyatt measure [ 59 ] to capture post-treatment scores. When pooling data with the SMD, we noted a balanced effect in both groups (SMD 0.0, 95% CI −0.16–0.16, I 2 =22%, moderate certainty).…”

“…The overall symptom score, comprising breathlessness, cough and wheezing, with or without sputum, was similar in both groups post-treatment (SMD 0.00, 95% CI −0.91–0.90, I 2 =90%, 200 participants, very low certainty), according to two trials using a nonvalidated score [ 37 ] or the symptoms subscore of the SGRQ-C [ 53 ]. Improvement in post-treatment scores was reportedly similar in the S tällberg et al [ 54 ] (109 participants, CCQ symptoms subscore) and D jordjevic et al [ 42 ] (60 participants, score not described) trials.…”