Effectiveness of nebulised budesonide therapy for chronic obstructive pulmonary disease with respiratery failure requiring mechanical ventilation for an exacerbation

Abstract

Objective To evaluate the safety and efficacy of nebulised budesonide suspension compared with systemic corticosteroid in the treatment of chronic obstructive pulmonary disease （COPD） patients with respiratory failure requiring mechanical ventilation for an exacerbation. Methods COPD patients for an exacerbation were prospectively enrolled in the study. Informed consent was obtained from all the participants. The patients from November, 2009 to December, 2011 were randomly sorted into three groups. The treatment groups were as follows. Control group received bronchodilator treatment with nebulised salbutamol （2 ml,Q6h） and nebulised ipratropium bromide （0.5 mg q. i. d. ） in separate sessions. Methylprednisolone group received systemic corticosteroids with methylprednisolone （i. v. 40 mg q. i. d. ） for 5 days beside the same bronchodilator treatments as control group. Budesonide group received nebulised corticosteroids with nebulised budesonide （2 rag, Q8h） for 5 days beside the same bronchodilator treatments as control group. All patients were given mechanical ventilation and antibiotics that were used according to patientts condition. IL-8 of induced sputum and absolute blood glucose level were detected at 1 h,72 h,5 d,7 d for mechanical ventilation. Results 48 patients completed the study （15in control group, 17 in methylprednisolone group, 16 in budesonide group）. At 1 h for mechanical ventilation, there is no statistical difference for sputum IL-8,TNF-α and CRP in three groups. At 72 h for mechanical ventilation, Sputum IL-8,TNF-α and CRP in methylprednisolone group and budesonide group were lower than those at 1 h （ P〈0.05）. At 5 d for mechanical ventilation, Sputum IL-8, TNF-α and CRP in control group was lower than those at 1 h （ P =0. 023）. At 7 d sputum IL-8,TNF-α and CRP in methylprednisolone group and budesonide group were lower than those in control group （ P〈0.05）. There is no statistical difference for sputum IL-8, TNF-αand CRP levels at 72 h, 5 d, 7 d between methylprednisolone group and budesonide group （ P〈0.05）. Blood glucose exhibited an upward trend only in methylprednisolone group. Conclusions Nebulised budesonide exerted less systemic activity than systemic corticosteroid administration, as indicated by serial blood glucose measurements. In conclusion, the data suggest that high-dose nebulised budesonide may be an alternative to systemic corticosteroids in the treatment of exacerbations of COPD. Key words: Nebulised budesonide; Chronic obstructive pulmonary disease; Respiratory failure; Mmechanical ventilation