The role of nebulised budesonide in the treatment of exacerbations of COPD

Günen, Hakan; Hacievlıyagıl, Süleyman Savaş; Yetkin, Özkan; Gülbaş, Gazi; Mutlu, Levent Cem; İn, Erdal

doi:10.1183/09031936.00073506

Cited by 90 publications

(95 citation statements)

References 28 publications

(46 reference statements)

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confidence: 99%

The role of nebulised budesonide in the treatment of acute exacerbations of COPD

Günen¹,

Hacievlıyagıl²,

Yetkin³

et al. 2007

European Respiratory Journal

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From the authors:We have read with interest the letter concerning our manuscript recently published in the European Respiratory Journal [1] and appreciate the concerns raised by A. Singh. Underlining chronic obstructive pulmonary disease (COPD) as a systemic disorder has gained wide acceptance among pulmonary physicians. The main evidence supporting this approach is the increased levels of systemic inflammatory markers (tumour necrosis factor-a, C-reactive protein and interleukins) and the presence of cachexia and muscle weakness/wasting [2,3]. It is not yet known what kind of extrapulmonary problems these increased inflammatory markers indicate or give rise to. They have been shown to be strongly related to the level of inflammation in the lungs, and do not seem to indicate any kind of abnormal systemic process independent of the pathology within the lungs of COPD patients [4]. Cachexia and muscle weakness/wasting mainly occur due to the increased work of breathing, decreased appetite and avoidance of eating behavior due to increased breathlessness in COPD patients.It is still not clear which potential systemic abnormalities occurring during exacerbations of COPD (ECOPD) may be relieved by systemic corticosteroid administration alone. Therefore, from a practical point of view, we are not yet convinced that there is a significant difference between treating COPD as a systemic or local disease. Secondly, the rationale of high-dose nebulised corticosteroid administration in severe COPD is the same as that for the administration of systemic corticosteroids. No published data currently exist that directly test the efficacy of systemic corticosteroid administration and the severity of COPD exacerbation according to dominant cell type in the lower airways. Nebulised corticosteroid administration has the advantage of enabling the clinician to avoid the systemic side-effects of corticosteroids. Thirdly, it is difficult to discuss the response to high-dose nebulised corticosteroid administration according to the cause of exacerbation and the dominant cell type in any specific cause of exacerbation, due to a lack of any published data. These issues were not addressed in our study. However, it must be remembered that since patients were randomly included in our study, there should be no difference between the groups with respect to the cause of exacerbation and dominant cell type in the lower airways. The important point here is that we did not find any difference between the efficacies of high-dose nebulised budesonide and systemic corticosteroid administration, with a lower side-effect profile in the nebulised corticosteroid arm. We agree with A. Singh that 10% of patients with COPD have some characteristics of asthma, and their response to the high-dose nebulised budesonide may potentially differ from that of other COPD patients. However, these patients were not excluded or were not separately evaluated in our study. We believe that if any COPD patients with asthmatic features were included in our study, they did not ha...

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confidence: 99%

The role of nebulised budesonide in the treatment of acute exacerbations of COPD

Günen¹,

Hacievlıyagıl²,

Yetkin³

et al. 2007

European Respiratory Journal

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“…Yan etki riskinin yüksek olduğu hastalarda (kontrol altında olmayan diyabet ya da hipertansiyon vb.) nebülizatör ile inhale steroid kullanımının benzer etkinlik sağladığı bildirilmiştir (164,165).…”

Section: Koah Ataklarında Bronkodilatör Tedaviunclassified

Acute exacerbation in COPD and asthma

Yıldırım

Demir²,

Gemicioğlu³

et al. 2015

Tuberk Toraks

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“…Бактериоло-гическое исследование мокроты не выполне-но в 31,6% случаев первой госпитализации, в 32,6% второй и в 40% третьей. Отметим, что у 1 пациента при первой госпитализации был выявлен рост Haemophilus parainfluenzae в ти-тре 1×10 6 колониеобразующих единиц (КОЕ) на 1 мл, у 1 больного при вторичной госпита-лизации -Enterococcus faecalis 1×10 3 КОЕ/мл. В остальных случаях этиологически значимо-го роста микрофлоры получено не было, что в какой-то степени позволяет подозревать не-адекватность забора материала на бактерио-логическое исследование.…”

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“…Так, в исследо-вании Н. Gunen и соавт. (2014) было показа-но достоверное увеличение уровня глюкозы в крови у пациентов, принимающих внутрь преднизолон, в сравнении с пациентами, получающими бронходилататоры или их сочетание с будесонидом [6].…”

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Readmissions for chronic obstructive pulmonary disease in actual clinical practice

et al. 2018

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Казанский государственный медицинский университет, г. Казань, Россия РефератЦель. Выявление факторов риска повторных госпитализаций, связанных с обострением хронической обструк-тивной болезни лёгких, с последующей идентификацией возможных дефектов качества оказания медицинской помощи пациентам на амбулаторном и госпитальном этапах. Методы. Проведён ретроспективный анализ медицинских карт пациентов с обострением хронической обструк-тивной болезни лёгких, госпитализированных два раза и более в терапевтическое отделение одного из стацио-наров г. Казани в период с 1 января 2015 г. по 30 июня 2016 г. Результаты. Выявлено, что факторы риска повторных госпитализаций -мужской пол (относительный риск 2,29, 95% доверительный интервал 0,78-6,69; р ˂0,05), возраст старше 70 лет (относительный риск 2,069, 95% доверительный интервал 1,01-4,2; р ˂0,05), стаж курения 40 лет и более (относительный риск 5,3, 95% довери-тельный интервал 1,6-17,5; р ˂0,05), продолжительность заболевания более 6 лет (относительный риск 2,4, 95% доверительный интервал 0,98-6,18; р ˂0,05), наличие трёх и более сопутствующих заболеваний, в первую оче-редь сердечно-сосудистых (относительный риск 13,0, 95% доверительный интервал 1,89-90,14; р ˂0,05). Важ-ные причины последующих обострений после выписки из стационара -низкая приверженность пациентов к лечению и дефекты оказания медицинской помощи в стационаре. Вывод. Выявленные дефекты качества оказания медицинской помощи свидетельствуют о необходимости ак-тивизации внедрения положений федеральных клинических рекомендаций по хронической обструктивной бо-лезни лёгких в реальную врачебную практику; в связи со сложностью модификации выявленных факторов ри-ска основные усилия должны быть направлены на оптимизацию лечения с контролем приверженности, а также полноценное использование потенциала немедикаментозного лечения в виде рекомендаций по сохранению фи-зической активности, раннему отказу от курения и реабилитации больных. Ключевые слова: хроническая обструктивная болезнь лёгких, ХОБЛ, повторные госпитализации, факторы риска. Readmissions for chronic obstructive pulmonary disease in actual clinical practice A.F. Yakupova, A.R. Zinnatullina, R.F. Khamitov Kazan State Medical University, Kazan, RussiaAim. Identification of risk factors for readmissions associated with exacerbation of chronic obstructive pulmonary disease followed by identification of possible quality defects in the provision of medical care to patients in the outpatient and hospital stages. Methods. A retrospective analysis of the medical records of patients with exacerbation of chronic obstructive pulmonary disease admitted twice or more to the therapeutic department of one of the hospitals of Kazan during the period from January 1, 2015 to June 30, 2016. Results. The risk factors for readmissions were found to be the following: male sex (relative risk 2.29; 95% CI 0.78-6.69; р ˂0.05), age over 70 years (relative risk 2.069; 95% CI 1.01-4.2; р ˂0.05), smoking for more than 40 years (relative risk 5.3; 95% CI 1.6-17.5; р ˂0.05), duration of t...

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The role of nebulised budesonide in the treatment of exacerbations of COPD

Cited by 90 publications

References 28 publications

The role of nebulised budesonide in the treatment of acute exacerbations of COPD

The role of nebulised budesonide in the treatment of acute exacerbations of COPD

Acute exacerbation in COPD and asthma

Readmissions for chronic obstructive pulmonary disease in actual clinical practice

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