Short-Term Versus Long-Term Systemic Corticosteroid Use in the Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients.

Samah Alshehri,Ahmed Alhuwaysi,Mohammed Alageeli,Mai Alalawi,Mohannad Alshibani,Abdulrahman Makeen,Ammar Jad

doi:10.21315/mjms2021.28.1.8

Abstract

BackgroundThe administration of systemic corticosteroids in chronic obstructive pulmonary disease (COPD) exacerbation is the first line of management. The duration of this administration, however, is not well established in clinical practice. The objective of this study is to compare the clinical outcomes between short-term and long-term corticosteroid use in the acute exacerbation of COPD patients.MethodsA single-centre, retrospective cohort study was conducted. From 2014 to 2018, all patients over 40 years old with COPD who were admitted to the hospital with a case of COPD exacerbation and received systemic corticosteroids at presentation were included. The subjects were divided into two groups according to the duration of systemic corticosteroid therapy. The primary outcome was hospital re-admission within 180 days. The secondary outcomes were 30 days mortality and length of hospitalisation. The two groups were compared using an independent sample t-test, a Chi-square test, and a Mann-Whitney U test, according to the data type.ResultsEighty patients met the inclusion criteria. A total of 52 (65%) patients completed long-term therapy, while 28 (35%) patients were on short-term treatment. A total of 15 (28.8%) patients reached the primary endpoint in the long-term treatment group versus 19 (67.9%) in the short-term treatment group (P = 0.001). The 30-day mortality was 4 (7.7%) and 0 (0%), respectively, and the median length of hospitalisation was 6.5 and 7.5 days in the long-term group and short-term group, respectively (P = 0.32, P = 0.88).ConclusionLong-term corticosteroid use in the management of acute COPD exacerbation was significantly associated with fewer 180 days re-admission. The duration of corticosteroid use remains controversial, and further studies are recommended to assess the relationship between patient profile and adherence to therapy post-discharge with re-exacerbation.

Highlights

Chronic obstructive pulmonary disease (COPD) is considered to be a complex, progressive life-threatening lung disease [1]
The aim of this study is to investigate whether or not there are any differences in clinical outcomes between short-term versus long-term corticosteroid administration defined as re-admission within 180 days
The criteria for eligibility were all patients over 40 years old with a primary diagnosis of acute chronic obstructive pulmonary disease (COPD) exacerbation based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) diagnostic criteria who were admitted to hospital as a case of COPD exacerbation

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is considered to be a complex, progressive life-threatening lung disease [1]. The administration of systemic corticosteroids, along with shortacting beta-2 agonists, is considered the first line of management in COPD exacerbation [3]. Their rules have been established to reduce the frequency of exacerbations, minimise the urge of intubation, and lower the overall mortality rate [3, 4]. The administration of systemic corticosteroids in chronic obstructive pulmonary disease (COPD) exacerbation is the first line of management. The duration of this administration, is not well established in clinical practice. The objective of this study is to compare the clinical outcomes between short-term and long-term corticosteroid use in the acute exacerbation of COPD patients

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Methods

Results

Discussion

Conclusion