An Association Between Different Doses of Inhaled Corticosteroids and Glycaemic Status in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Introduction: Inhaled corticosteroids effective medications for the treatment of asthma. Higher doses of inhaled fluticasone (1000 μgm / day) are commonly used in COPD. Such high doses have been associate with significant systemic effects such as pneumonia, glaucoma, cataracts, adrenal suppression and accelerated bone turnover. Aim of the study: The aim of the study was to evaluate the association between different doses of inhaled corticosteroids (Fluticasone Propionate µgm / day) and glycaemic status in Patients with Chronic Obstructive Pulmonary Disease. Material & Methods: This was a cross-sectional analytical study. This study was conducted at the department of Internal Medicine in Bangobandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during May, 2016-April, 2017. The protocol of this study was approved by IRB and ethical committee. A total of 80 patients with COPD were included in this study, of them clinically diagnosed 40 consecutive COPD patients who were receiving both bronchodilator & inhaled corticosteroids were recruited as case group and clinically diagnosed 40 consecutive COPD patients receiving only bronchodilator without inhaled corticosteroid/systemic steroid were recruited as control, group. Spirometry was done for confirmation and staging of COPD according to GOLD at indoor and OPD patients of Department of Internal Medicine, BSMMU. Results: In case group, the inhaled corticosteroid dose (5000) was counted 02 (5%) and the mean of FPG value was 6.25±1.34, the inhaled corticosteroid dose (1000) was counted 27 (67.5%) and the mean of FPG value was 5.7±1.58, the inhaled corticosteroid dose (2000) was counted 11 (27.5%) and the mean of FPG value was 6.58±2.24. The total FPG mean of the doses was 5.97±1.78. Among case group according to inhaled corticosteroid dose in case group, the inhaled corticosteroid dose (500) was counted 02 (5%) and the mean of 2HABF value was 9.65±3.18, the inhaled corticosteroid dose (1000) was counted 27 (67.5%) and the mean of 2HABF value was 8.71±2.84, the inhaled corticosteroid dose (2000) was counted 11 (27.5%) and the mean of 2HABF value was 9.51±2.9. The total mean of 2HABF value of the doses was 8.98±2.82. In case group, the inhaled corticosteroid dose (500) was counted 02 (5%) and the mean of HbA1C value was 5.85±1.06, the inhaled corticosteroid dose (1000) was counted 27 (67.5%) and the mean of HbA1C value was 6.07±0.7, the inhaled corticosteroid dose (2000) was counted 11 (27.5%) and the mean of HbA1C value was 6.7±0.74. The total mean of HbA1C value of the doses was 6.23±0.77. Conclusion: We had found that 32% of cases and 7.5% of control group were diagnosed as diabetic when fasting plasma glucose taken into account, while in case of 2 hours after breakfast plasma sugar the number were 32.5% and 10% respectively and in case of HbA1c the number were 23.5% and 10% respectively.