High-Dose Versus Low-Dose Systemic Steroids in the Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Systematic Review

Arcos, Diego Bonilla; Krishnan, Jerry A.; Vandivier, R. William; Sevransky, Jonathan; Checkley, William; Kiser, Tyree H.; Sullivan, Jamie; Walsh, John; Wise, Robert A.; Wilson, Kevin C.

doi:10.15326/jcopdf.3.2.2015.0178

Cited by 5 publications

(2 citation statements)

References 13 publications

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“…Chronic obstructive pulmonary disease (COPD) is a dynamic, ceaseless inflammation of airways with airflow impediment, which is not completely reversible in nature 8 . COPD is reported to have a pervasiveness of approximately 10% in those older than 40 years worldwide.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Respiratory failure [ 18 ], advanced age [ 8 ], and mechanical ventilation [ 9 ]—all of which are common in the PCCM department—are important risk factors for delirium in patients. In addition, glucocorticoids, which are commonly used in the PCCM department, are also an important factor leading to the occurrence of delirium [ 19 ]. Under the same nurse/bed ratio, the nurses in these three wards may have had to care for more delirium patients, thereby experiencing a higher degree of subjective strain of care.…”

Section: Discussionmentioning

confidence: 99%

Subjective strain of care experienced by pulmonary and critical care medical nurses when caring for patients with delirium: a cross-sectional study

Tan

Zhou

et al. 2021

BMC Health Serv Res

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Background Delirium, a disorder of consciousness, often occurs for a period of time during hospitalisation. It is characterised by a disturbance of attention or awareness. Hyperactive delirium may lead to accidental removal of medical equipment, while hypoactive delirium may inhibit patients from participating in nursing interventions, medical treatment, and physical therapy. However, there are limited relevant studies of the strain of care of nurses in China when caring for patients with delirium. This study, thus, aimed to investigate the subjective level of the strain of care experienced by pulmonary and critical care nurses when caring for patients with delirium. Methods This was a descriptive, cross-sectional study. A survey was conducted with 100 nurses in the Chinese pulmonary and critical care medical (PCCM) department in 2018. The Strain of Care for Delirium Index (SCDI) was used to measure nurses’ strain of care. Participants were instructed to rate the degree of perceived difficulty in managing patients who displayed the behaviours listed in the SCDI, on a scale from 1 (quite easy) to 4 (very difficult). The mean ± standard deviation (SD) scores of the ranked difficulty scores were calculated. Results In our sample, 47 % of the nurses had received delirium-related training previously. The three wards with the highest strain of care scores when caring for patients with delirium were the chronic obstructive pulmonary disease ward (3.29 ± 0.72), interstitial lung disease ward (3.11 ± 1.31), and respiratory intensive care unit (3.02 ± 0.78). The three types of patient behaviours associated with the highest degree of nursing strain of care were being uncooperative and difficult to manage (3.37 ± 0.84), pulling out tubes and tearing out dressings (3.33 ± 0.98), and irritability (3.22 ± 0.95). Conclusions This study is the first to focus on nurses’ subjective strain of care when caring for patients with delirium in PCCM departments in China. The findings suggest the need to pay more attention to the working status of Chinese nurses. Further trials with large samples assessing relevant outcomes of patients with delirium are warranted.

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Pristimerin alleviates cigarette smoke-induced inflammation in chronic obstructive pulmonary disease via inhibiting NF-κB pathway

Huang

et al. 2022

Biochem. Cell Biol.

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Cigarette smoke (CS) is a risk factor for chronic obstructive pulmonary disease (COPD), which can exacerbate inflammation and oxidative stress. Pristimerin (Pris) is a natural compound with antioxidant and anti-inflammatory effects. We managed to evaluate the protective effects of Pris on CS-induced COPD. The CS-induced COPD mice model and cell model were constructed. The effects of Pris treatment on lung function, inflammatory cell infiltration, myeloperoxidase (MPO), and pathological changes of lung tissues in mice model were evaluated. The impacts of Pris treatment on inflammatory factors, chemokines, and oxidative stress parameters in mice lung tissues and cells were determined by kits. The viability of human bronchial epithelial cells after Pris treatment was tested by CCK-8. The activation of NF-κB pathway was confirmed by Western blot and immunofluorescence. CS treatment impaired lung function, reduced weight of mice, and enhanced inflammatory cell infiltration, MPO, and lung tissue damage, but these effects of CS were reversed by Pris treatment. Furthermore, Pris treatment downregulated the levels of malondialdehyde, IL-6, IL-1β, TNF-α, CXCL1, and CXLC2, but upregulated superoxide dismutase and catalase levels. Pris treatment could overturn CS-induced activation of the NF-κB pathway. Pris alleviates CS-induced COPD by inactivating NF-κB pathway.

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High-Dose Versus Low-Dose Systemic Steroids in the Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Systematic Review

Cited by 5 publications

References 13 publications

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

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

Subjective strain of care experienced by pulmonary and critical care medical nurses when caring for patients with delirium: a cross-sectional study

Pristimerin alleviates cigarette smoke-induced inflammation in chronic obstructive pulmonary disease via inhibiting NF-κB pathway

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