Abstract
BackgroundThere are insufficient data on the optimum duration of systemic steroid therapy during acute exacerbation of chronic obstructive pulmonary disease (COPD).AimTo evaluate the outcome of short-term systemic steroid therapy in patients hospitalized with acute exacerbation of COPD and to identify factors associated with treatment failure.Patients and methodsFifty severe and very severe COPD patients with acute exacerbation were consecutively included in this study. Patients were assessed by a clinical symptom score, peak expiratory flow rate (PEFR), arterial blood gases and laboratory investigations [blood count indices, high sensitive C-reactive protein, erythrocyte sedimentation rate (ESR) and fibrinogen level]. Short-term systemic steroids were initiated and the outcome was assessed at day 5 of therapy and the patients were classified into treatment success group or failure group.ResultsTreatment failure was observed in 27 (54%) of patients. Patients with treatment failure had significantly higher cough and chest tightness scores, higher partial pressure of CO2 in arterial blood (PaCO2), lower partial pressure of O2 in arterial blood (PaO2), lower PEFR, higher red distribution width (RDW), and higher ESR compared with the success group. By binary logistic regression, higher PaCO2, lower PaO2, and higher ESR were independent risk factors associated with treatment failure. The optimum cutoff level of PaCO2, PaO2, and PEFR associated with treatment failure was more than or equal to 59.5 mmHg, up to 43.5 mmHg, and up to 225 l/min, respectively. ESR first hour of at least 35 and RDW of at least 15.5% were also associated with treatment failure.ConclusionMost severe and very severe COPD during acute exacerbations need prolonged course of systemic steroids (>5 days). Clinical evaluation, gasometric parameters, PEFR, RDW, and ESR could be good predictors of treatment failure on short-term systemic steroid.
Highlights
Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease, characterized by airflow limitation and persistent respiratory symptoms that is usually progressive and is associated with an enhanced chronic inflammatory response in the airways to noxious particles or gases [1]
Patients with treatment failure had significantly higher cough and chest tightness scores, higher partial pressure of CO2 in arterial blood (PaCO2), lower partial pressure of O2 in arterial blood (PaO2), lower peak expiratory flow rate (PEFR), higher red distribution width (RDW), and higher erythrocyte sedimentation rate (ESR) compared with the success group
This study included 50 severe and very severe COPD patients hospitalized with acute exacerbation
Summary
Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease, characterized by airflow limitation and persistent respiratory symptoms that is usually progressive and is associated with an enhanced chronic inflammatory response in the airways to noxious particles or gases [1]. During the course of the disease, periods of exacerbations or flares up may occur [2]. Inflammatory markers such as tumor necrosis factor-α [3,4] and inflammatory cells such as neutrophils [5], eosinophils [6], and cluster of differentiation 4 (CD4) cells [7] are collected in the respiratory system causing local inflammation. The fibrinogen level is increased when purulent sputum is observed during exacerbations [8]. The C-reactive protein (CRP) levels are increased in bacterial acute exacerbation of chronic obstructive pulmonary disease (AECOPD) [9]. There are insufficient data on the optimum duration of systemic steroid therapy during acute exacerbation of chronic obstructive pulmonary disease (COPD)
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