EVALUATION OF EFFECT OF INHALED CORTICOSTEROID (ICS) ON SPIROMETRIC PARAMETERS OF COPD PATIENTS

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death in the world but is projected to be the 3rd leading cause of death by 2020. More than 3 million people died of COPD in 2012 accounting for 6% of all deaths globally. COPD represent an important public health challenge that is both preventable and treatable. COPD is a major cause of chronic morbidity and mortality throughout the world; many people suffer from this disease for years, and die prematurely from it or its complications. Afghanistan is also one of those countries in which the mortality rate of COPD has gradually increased, therefore this problem needs prompt attention and is more essential to focus on. Objective: This study aimed to determine and evaluate the effect of inhaled corticosteroid (ICS) on Spirometric parameters of COPD patients and association between inhaled corticosteroid (ICS) and changes of spirometric parameters of various age groups, gender and smokers in OPD patients of COPD of Khost province of Afghanistan. Material and Methods: It is prospective observational research, on 100 COPD patients in Khost province from 2019/3/22 to 2019/8/24. Spirometric parameters of all 100 patients under study (research) after diagnosis of COPD before treatment such as FVC, FEV1 and PEFR by (ME1 2AZ) model spirometer manufactured by (VYair) Company in (2005), diagnosed and recorded in computer special format, then inhaled corticosteroids therapy prescribed for three months and prescriptions are copied. After three months of treatment, the spirometric parameters of all 100 patients under study (research) were re-diagnosed and recorded using this model spirometer. The pre-treatment and post-treatment recorded spirometric parameters processing, comparison and evaluation results have been identified by IBM SPSS-25 version. Results: The study was conducted over a five month period from March 2019 to August 2019 in 100 COPD patients in Khost province. Initially the effects of ICS on spirometric parameters were evaluated in all COPD patients and it was proved that ICS has a positive impact on all three spirometric parameters of all age groups, The average FEV1 before ICS is 67.13 ∓3,79 and after ICS is 74.69 ∓3,70 the positive improvement between the average is 7.56%. Average FVC before ICS is 74.37 ∓4,33 and after ICS is 81.71 ∓ 4,41, improvement between average is 7.34%. Average PEFR before ICS is 67.15 ∓ 7,46 and after ICS 83.53 ∓ 7,39, improvement between average is 16.38%.The progression between the average is seen in all parameters, but the effect on PEFR (16.38%) is more pronounced than in FEV1 and FVC and in all three parameters P less then 0.05(see table-1). The effects of ICS on all three spirometric parameters in different age groups of total COPD patients showed that ICS affects all age groups, but the age group VI (70-79Y) has an average of 67.43 FEV1 before ICS and 75.86 after ICS, with a positive improvement between the average of 8.43%.The FVC average before ICS is 74.63 and after ICS is 83.23, the improvement between the average is 8.60%. The average PEFR before ICS is 64.96 and after ICS is 82.60, the improvement between the average is 17.63%. The effect of ICS is most pronounced on all three spirometric parameters of this age category. The second row has a significant effect on the group VII (80-90Y) and the third row has a significant effect on the group V (60-69Y). The effect of ICS gradually decreases from the first group I (22-29Y), this meaning that ICS is more effective in older age groups than in younger age groups (see table-2). Research on gender, tobacco use, and middle age in all COPD patients showed that the Khost province's COPD prevalence was 23 (23%) in males and 77 (77%) in females. COPD is more prevalent in female (77%) than in male. Also, smoking does not significantly affect the prevalence of COPD, as the total percentage of smokers is 9 (9%) and the average age of patients with COPD is 61.05 years (see Table 3). Conclusion: Overall, the findings indicated that ICS has a positive impact on spirometric parameters of all age groups of COPD patients, but ICS has significant effect on PEFR parameter. ICS also has a positive impact on spirometric parameters of all age groups of COPD patients, but ICS have a significant effect on spirometric parameters of VI-(70-79Y) and V-(60-69Y) age groups and ICS effect in young age groups gradually decreased. Moreover prevalence of COPD at Khost province is significantly increased in female. Smoking has not significant effect on prevalence of COPD. Mean age if COPD patients elderly at Khost province.