Abstract
BackgroundSystemic corticosteroids (SCS) are effective in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, they are not without adverse effects, especially hyperglycemia. Inhaled corticosteroids (ICS) showed satisfactory outcomes with good safety. These benefits were not evaluated in patients with AECOPD with diabetes mellitus. The aim was to compare the efficacy and safety of high dose of ICS vs SCS in the treatment of AECOPD in diabetic patients.Patients and methodsA total of 126 patients with AECOPD were screened, and thirty of them were found to be eligible and were enrolled into two groups: group 1 (n=15) received 1mg budesonide by jet nebulizer four times daily, and group 2 (n=15) received 40mg prednisolone or equivalent systemically. Postbronchodilator forced expiratory volume in 1 s (FEV1%) of predicted was measured at day 1 and day 7, and random blood sugar (RBG) was measured twice daily in all patients.ResultsThere was a significant increase in the mean FEV1 at day 7 as compared with mean FEV1 at day 1 in groups 1 and 2, with the increase in mean FEV1 being 19.6 and 21% in groups 1 and 2, respectively. There was a significant difference, with higher mean RBG in group 2 when compared with group 1, at day 4 of treatment and continued onward. Interestingly, there was a significant elevation in mean RBG among patients in group 2 (SCS) starting by day 3 of treatment and continued onward, with no significant rise in the first two days, although there was no evident effect of ICS on the mean RBG among patients in group 1 (ICS) during the follow-up days.ConclusionBoth ICS and SCS improve airflow in patients with AECOPD, taking into consideration the existence of diabetes mellitus. ICS may be an excellent substitute to SCS in the treatment of AECOPD in diabetic patients.
Highlights
Acute exacerbation of chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation, and worldwide, it is presumed to become the third leading cause of death in 2030 [1].Patients with COPD have a greater risk for diabetes mellitus (DM) type II [2]
All patients were subjected to the following at presentation: thorough history taking and clinical examination; posteroanterior chest radiography; complete blood count; oxygen saturation measurement by pulse oximetry and/or arterial blood gas analysis on room air; postbronchodilator spirometry for measurement of forced expiratory volume in 1 s (FEV1)% of predicted at day 1 and at day 7 using spirometer device (ZAN 600 USB nSpire Health GmbH, Oberthulba, Germany); severity assessment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria; and random blood glucose level (RBG) assessment at least twice daily for 7 days
There is no statistically significant difference between group 1 and group 2 regarding the mean of FEV1/ forced vital capacity (FVC) ratio on admission, FEV1 at day 1, and FEV1 at day 7
Summary
Patients with COPD have a greater risk for diabetes mellitus (DM) type II [2]. Predisposing factors such as oxidative stress, systemic inflammation, insulin resistance, abnormal adipocyte metabolism, and weight increase, all participate in the ongoing pathophysiology. Systemic corticosteroids (SCS) are effective in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). They are not without adverse effects, especially hyperglycemia. Inhaled corticosteroids (ICS) showed satisfactory outcomes with good safety. These benefits were not evaluated in patients with AECOPD with diabetes mellitus. The aim was to compare the efficacy and safety of high dose of ICS vs SCS in the treatment of AECOPD in diabetic patients
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