Short-term systemic steroid therapy in chronic obstructive pulmonary disease patients with acute respiratory failure

Abstract

Background: There are insufficient data on the optimum duration of systemic steroid therapy during acute exacerbation of COPD. Aim To evaluate the outcome of short-term systemic steroid therapy in patients hospitalized with acute exacerbation COPD. Methods: Fifty 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. Results: Treatment failure was observed in 27 (54%) patients who had significantly higher cough and chest tightness scores, higher (PaCO2), lower (PaO2), lower PEFR, higher red distribution width (RDW), higher fibrinogen level 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 in treatment failure patients 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 Conclusion: Most severe and very severe COPD during acute exacerbations need prolonged course of systemic steroids (>5 days). Gasometrical parameters, PEFR, RDW, and ESR could be good predictors of treatment failure.