Nebulized Corticosteroids in the Treatment of COPD Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

Pleasants, Roy A.; Wang, Tiansheng; Xu, Xiangyu; Beiko, Tatsiana; He, Ben; Zhai, Suodi; Drummond, M. Bradley

doi:10.4187/respcare.06384

Cited by 15 publications

(15 citation statements)

References 41 publications

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“…The pooled effects of two previous meta‐analysis also found no significant differences of change in pulmonary function and blood gases in patients of COPD exacerbations treated by ICS or SCs. Although clear similarities exist between the previous analyses and our analysis, differences remain.…”

Section: Discussionmentioning

confidence: 81%

“…In addition to this, we combined the arms of different dosing of nebulized budesonide reported by Yilmazel Ucar E et al, whereas the previous meta‐analysis by Zhai Y et al did not. Second, compared with the previous meta‐analysis by Pleasants RA et al, our review included three fewer RCTs, which were clinical controlled trials of Han W et al, Guozhong C et al and Maltais F et al They were not included in our analysis because of major flaws in their trial design and no complete data provided. In addition, our analysis evaluated more indicators than that of Pleasants RA et al, and subgroup analysis was performed at various time points after treatment (24 hours, 48‐72 hours, 5‐7 days).…”

Section: Discussionmentioning

confidence: 99%

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Comparative efficacies of nebulized budesonide and systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease: A systematic review and meta‐analysis

et al. 2020

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What is known and objective Corticosteroids are recommended by almost all international guidelines for the management of exacerbations of chronic obstructive pulmonary disease (COPD). Nevertheless, due to their side effects, there are still concerns regarding the use of systemic corticosteroids (SCs). The Global Initiative for Chronic Obstructive Lung Disease guideline states nebulized budesonide (NB) may be a suitable alternative to SCs for treating COPD exacerbations. We conducted this study to systematically compare the efficacies of NB and SCs by using a meta‐analysis. Methods PubMed, EMBASE and Cochrane Library databases were searched from database inception to 10 October 2019. Our main end points were change in pulmonary function and blood gas analysis. Secondary end points were numbers of exacerbations and hyperglycaemia. Results and discussion Of 645 identified studies, 6 were eligible and were included in our analysis (N = 867 participants). Compared with SCs, NB was non‐inferior on the change in FEV1%predicted at 24 hours, 48‐72 hours and 5‐7 days; FEV1 at 5‐7 days; FEV1/FVC at 7 days. For blood gas analysis, our meta‐analysis indicated that PaO2, PaCO2 at 24 hours, 48‐72 hours and 7‐10 days and SaO2 at 24 hours and 7‐10 days showed a non‐significant difference in both groups, whereas the SaO2 was significant higher in NB group at 48‐72 hours after treatment. Hyperglycaemia was less frequent with NB (odds ratio, 0.1; 95% CI, 0.01‐0.85; P = .04). What is new and conclusion Based on our meta‐analysis, NB was not inferior to SCs when used in the treatment of COPD exacerbations. However, additional well‐designed prospective studies are needed to identify the optimal dose of nebulized budesonide and the effects of nebulized budesonide in outpatients, or patients in ICU settings.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Comparative efficacies of nebulized budesonide and systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease: A systematic review and meta‐analysis

et al. 2020

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“…Diseases requiring inhalation therapies include asthma, bronchiectasis, COPD, CF, pneumonia, and ARDS [34][35][36]. Common nebulized medications used to treat these conditions include antibiotics [37,38], various bronchodilators, such as albuterol sulfate [39] and ipratropium bromide [40], and corticosteroids, such as budesonide [41].…”

Section: Development Of Nebulizersmentioning

confidence: 99%

Future Trends in Nebulized Therapies for Pulmonary Disease

McCarthy

González

Higgins

2020

JPM

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Aerosol therapy is a key modality for drug delivery to the lungs of respiratory disease patients. Aerosol therapy improves therapeutic effects by directly targeting diseased lung regions for rapid onset of action, requiring smaller doses than oral or intravenous delivery and minimizing systemic side effects. In order to optimize treatment of critically ill patients, the efficacy of aerosol therapy depends on lung morphology, breathing patterns, aerosol droplet characteristics, disease, mechanical ventilation, pharmacokinetics, and the pharmacodynamics of cell-drug interactions. While aerosol characteristics are influenced by drug formulations and device mechanisms, most other factors are reliant on individual patient variables. This has led to increased efforts towards more personalized therapeutic approaches to optimize pulmonary drug delivery and improve selection of effective drug types for individual patients. Vibrating mesh nebulizers (VMN) are the dominant device in clinical trials involving mechanical ventilation and emerging drugs. In this review, we consider the use of VMN during mechanical ventilation in intensive care units. We aim to link VMN fundamentals to applications in mechanically ventilated patients and look to the future use of VMN in emerging personalized therapeutic drugs.

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“…[17][18][19][20] Recently, clinical studies and Metaanalysis have shown that nebulized budesonide (NB) is as effective as systemic corticosteroids in controlling nonacidotic AECOPD, as evaluated by clinical symptoms, lung function, and blood gas analysis. Furthermore, NB treatment reduces side effects [17][18][19][20][21][22] and medicine costs 23 compared to systemic corticosteroids. GOLD guidelines suggest NB as a suitable alternative to systemic corticosteroids in the treatment of exacerbations in some patients.…”

Section: Introductionmentioning

confidence: 99%

<p>Optimization of Nebulized Budesonide in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease</p>

Zhang

Zhu

Liu

et al. 2020

COPD

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Background: Clinical studies have suggested nebulized budesonide (NB) as an alternative to systemic corticosteroids for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the optimal budesonide dose for AECOPD remains unclear. Objectives: To compare the efficacy and safety of different doses of NB in the management of AECOPD. Patients and Methods: A total of 321 AECOPD patients with moderate-to-severe exacerbation were randomly divided into three groups and treated with NB. The low dose group (L) was given 4 mg/day (n=95, 1 mg Q6h), while high-dose group 1 (H1, n=111, 2 mg Q6h) and high-dose group 2 (H2, n=115, 4 mg Q12h) were given 8 mg/day. Patients also received routine treatment including oxygen therapy, expectorant, nebulization bronchodilators, antibiotics, and fluid rehydration. The COPD assessment test (CAT), lung function, and artery blood gas were evaluated before and after 3 hrs and 5 days of treatment. In addition, hospital stay, frequency of acute exacerbations within 3 months of discharge, and adverse events during treatment were compared. Results: H1 and H2 showed improved spirograms and CAT score faster than L. In H2, forced expiratory volume in 1 s (FEV 1 %) at 3 hrs and FEV 1 %, forced expiratory flow after 50% of the forced vital capacity has been exhaled (FEF 50%), mean forced expiratory flow between 25% and 75% of forced vital capacity (FEF 25-75%) and CAT score at 5 days were significantly improved compared to L. FEV 1 % improved most in H2, moderately in H1, and least in L, with significant differences between groups at 5 days. No differences between groups were observed in adverse effects, hospital stay, and frequency of exacerbations within 3 months of discharge. Conclusion: Compared to the conventional dose (4 mg/day), a high dose (8 mg/day) of NB improved pulmonary function and symptoms more effectively in the early treatment of AECOPD, especially when given as 4 mg twice daily.

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Nebulized Corticosteroids in the Treatment of COPD Exacerbations: Systematic Review, Meta-Analysis, and Clinical Perspective

Cited by 15 publications

References 41 publications

Comparative efficacies of nebulized budesonide and systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease: A systematic review and meta‐analysis

Comparative efficacies of nebulized budesonide and systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease: A systematic review and meta‐analysis

Future Trends in Nebulized Therapies for Pulmonary Disease

<p>Optimization of Nebulized Budesonide in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease</p>

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