Extended Versus Short-Course Corticosteroid Taper Regimens in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Critically Ill Patients

Poon, Teresa; Paris, Daryl; Aitken, Samuel L; Patrawalla, Paru; Bondarsky, Eric; Altshuler, Jerry

doi:10.1177/0885066617741470

Cited by 8 publications

(6 citation statements)

References 16 publications

(28 reference statements)

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“…The difference in maximum systolic pressure was significant but not clinically relevant. Data from the literature promotes short courses with moderate doses of corticosteroids even for ICU patients [ 3 , 20 , 21 ] minimizing exposure to the drug. In a cohort of 17,239 patients, lower-doses of corticosteroid (methylprednisolone, ≤240 mg/d vs. >240 mg/d) were not associated with a significant reduction in mortality, but with reduced hospital and ICU length of stay, hospital costs, length of IMV, need for insulin therapy, and fungal infections [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a cohort of 17,239 patients, lower-doses of corticosteroid (methylprednisolone, ≤240 mg/d vs. >240 mg/d) were not associated with a significant reduction in mortality, but with reduced hospital and ICU length of stay, hospital costs, length of IMV, need for insulin therapy, and fungal infections [ 21 ]. Overall, in these studies, critically ill patients admitted for AECOPD were treated with higher doses than the recommended dose for non-ICU patients [ 20 , 21 ]. The question of the optimal corticosteroid dose for ICU patients therefore remains to be explored.…”

Section: Discussionmentioning

confidence: 99%

“…these studies, critically ill patients admitted for AECOPD were treated with higher doses than the recommended dose for non-ICU patients [20,21]. The question of the optimal corticosteroid dose for ICU patients therefore remains to be explored.…”

Section: Plos Onementioning

confidence: 99%

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Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort

et al. 2023

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Introduction Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a frequent cause of intensive care unit (ICU) admission. However, data are scarce and conflicting regarding the impact of systemic corticosteroid treatment in critically ill patients with acute exacerbation of COPD. The aim of the study was to assess the impact of systemic corticosteroids on the occurrence of death or need for continuous invasive mechanical ventilation at day 28 after ICU admission. Methods In the OutcomeReaTM prospective French national ICU database, we assessed the impact of corticosteroids at admission (daily dose ≥ 0.5 mg/kg of prednisone or equivalent during the first 24 hours ICU stay) on a composite outcome (death or invasive mechanical ventilation) using an inverse probability treatment weighting. Results Between January 1, 1997 and December 31, 2018, 391 out of 1,247 patients with acute exacerbations of COPDs received corticosteroids at ICU admission. Corticosteroids improved the main composite endpoint (OR = 0.70 [0.49; 0.99], p = 0.044. However, for the subgroup of most severe COPD patients, this did not occur (OR = 1.12 [0.53; 2.36], p = 0. 770). There was no significant impact of corticosteroids on rates of non-invasive ventilation failure, length of ICU or hospital stay, mortality or on the duration of mechanical ventilation. Patients on corticosteroids had the same prevalence of nosocomial infections as those without corticosteroids, but more glycaemic disorders. Conclusion Using systemic corticosteroids for acute exacerbation of COPD at ICU admission had a positive effect on a composite outcome defined by death or need for invasive mechanical ventilation at day 28.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort

et al. 2023

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“…Evidence also suggests that OCS improve lung function in ambulatory patients with COPD exacerbation and decrease the rate of hospitalizations, however, limited data on optimal corticosteroid dosage exist (80). A retrospective study in 151 patients with AECOPD admitted to the intensive care unit (ICU) indicated that the risk of treatment failure was similar in both extended-and short-course corticosteroid treatment groups, but the short-duration tapering group was associated with reduced length of hospital stay (81). In general, an equivalent dosage of 40-60 mg of prednisone for approximately 5 days is acceptable.…”

Section: Treatment Of Aecopdmentioning

confidence: 99%

Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians

Sorge

DeBlieux

2020

The Journal of Emergency Medicine

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Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a significant burden on patients and the emergency health care system. Patients with COPD who present to the emergency department (ED) often have comorbidities that can complicate their management. Objective: To discuss strategies for the management of acute exacerbations in the ED, from initial assessment through disposition, to enable effective patient care and minimize the risk of treatment failure and prevent hospital readmissions. Discussion: Establishing a correct diagnosis early on is critical; therefore, initial evaluations should be aimed at differentiating COPD exacerbations from other life-threatening conditions. Disposition decisions are based on the intensity of symptoms, presence of comorbidities, severity of the disease, and response to therapy. Patients who are appropriate for discharge from the ED should be prescribed evidence-based treatments and smoking cessation to prevent disease progression. A patient-centric discharge care plan should include medication reconciliation; bedside ''teach-back,'' wherein patients demonstrate proper inhaler usage; and prompt follow-up. Conclusions: An effective assessment, accurate diagnosis, and appropriate discharge plan for patients with AECOPD could improve treatment outcomes, reduce hospitalization, and decrease unplanned repeat visits to the ED.

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“…They are considering the non-inferior clinical outcome in an acute episode of COPD in patients receiving corticosteroids for a shorter period at equivalent doses compared to a longer period, as well as the benefits of reduced adverse events, low cost, and increased compliance. No need to taper off; this approach is the best way to treat indoor and outdoor COPD patients 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Short-Term Vs. Long-Term Glucocorticoids in COPD Exacerbation: A Comparative Efficacy Study

Israr¹,

Haq²,

Muhammad³

et al. 2023

PJMHS

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The current study aims to evaluate the comparative efficacy of short-term and long-term glucocorticoid treatment in patients with COPD exacerbation. A randomized clinical trial will compare the effectiveness of short-term and long-term glucocorticoid treatments in COPD exacerbation. One hundred ninety patients will be recruited and randomized into two groups: a short-term glucocorticoid group and a long-term glucocorticoid group. The primary outcomes will be assessed at the end of the treatment period to determine the efficacy of the treatments. Secondary effects will include quality of life, length of hospitalization, and adverse events. The results of this study will provide insight into the comparative efficacy of short-term and long-term glucocorticoid treatments in COPD exacerbation. Objective: Comparative efficacy of short-term (5-days) versus long-term (10-days) glucocorticoids at equivalent doses in managing COPD patients with acute exacerbations. Materials and Methods: Pakistan Institute of Medical Sciences (PIMS), Islamabad, conducted this randomized clinical trial in the inpatient pulmonology department. This research took six months following ethical clearance. The experiment included 190 patients in two groups of 95. Patients in the two groups were randomly administered Tab—prednisolone 5mg (40mg/24 Hours) for five days or ten days. Using a carefully constructed pro-forma, postgraduate residents gathered data on five parameters (FEV1, FEV1/FVC, Arterial Blood Gases, mMRC Dyspnoea Scale, Sputum color and amount, presentation with identical symptoms within 30 days following discharge). Results: Patients averaged 58.13 ± 11.12. Long-term patients were 58.34 ± 11.53 years old, whereas short-term patients were 57.93 ± 10.752. The short-term group included 86 (90.53%) male and 9 (9.47%) female cases, whereas the long-term group had 89 (93.68%) male and 6 (6.32%) female cases. Sputum color was normal in all groups after therapy. Short-term and long-term therapy groups had mean FEV1 changes of 8.12±4.85 and 7.14± 1.75, respectively. Following treatment, short-term mMRC was significantly lower (2.14±0.32) than long-term (2.73±0.44), with p-value < 0.001. The short-term group mMRC mean change was 1.67±0.53 compared to the long-term group 1.07±0.26, p-value < 0.001. Sputum amounts changed by 2.63 ± 1.67 in the short-term and 2.49 ± 0.72 in the long-term groups. Both groups had similar mean sputum quantities before, after, and after treatment, with a p-value > 0.05. Both groups had the same ABG parameter mean change following therapy. One month after discharge, neither group relapsed. Conclusion: The efficacy of short-term (5-days) glucocorticoids is better than long-term (10-days) glucocorticoids at equivalent doses in terms of mMRC reduction. At the same time, the therapeutic effect was statistically the same in both groups regarding improvement in FEV1, sputum color, sputum quantity, all parameters of ABGs, and relapse rates. Keywords: COPD, exacerbation, glucocorticoids, efficacy

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Extended Versus Short-Course Corticosteroid Taper Regimens in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Critically Ill Patients

Abstract: A short-course corticosteroid taper in critically ill patients with AECOPD is associated with reduced hospital length of stay and decreased corticosteroid exposure without increased risk of treatment failure. A prospective randomized trial is warranted.

Cited by 8 publications

References 16 publications

Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort

Corticosteroids for severe acute exacerbations of chronic obstructive pulmonary disease in intensive care: From the French OUTCOMEREA cohort

Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians

Short-Term Vs. Long-Term Glucocorticoids in COPD Exacerbation: A Comparative Efficacy Study

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