Inhaled Budesonide and Intravenous Methylprednisolone for Acute Exacerbation of COPD
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Patients treated in the hospital for an acute exacerbation of COPD were randomized to receive nebulized budesonide or intravenous methylprednisolone. There was a similar and significant improvement seen in symptoms, pulmonary function, and arterial blood gas analysis in both groups. The incidence of adverse events was significantly lower in the budesonide group than the methylprednisolone group. Length of hospital stay was comparable between the two groups, but PaO2 level improved more with methylprednisolone than with budesonide.
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Inhaled budesonide has similar efficacy and fewer adverse effects than systemic methylprednisolone and may be a suitable alternative treatment option in patients with acute exacerbation of COPD.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Almost all international guidelines recommend corticosteroids for management of exacerbations of chronic obstructive pulmonary disease (COPD), because it leads to improved outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Nevertheless, due to its side effects, there are still concerns regarding the use of systemic corticosteroid (SC). Inhaled corticosteroids (IC) can be used as an alternative to SC, while reducing the risk of occurrence of side effects.
PURPOSE
To measure the clinical efficacy and side effects of nebulized budesonide and systemic methylprednisolone in AECOPD.
METHODS
Valid data from 410 AECOPD patients in 10 hospitals was collected. Patients were randomly divided into 2 groups; budesonide group, treated with nebulized budesonide (2 mg 3 times/day); and methylprednisolone group, treated with intravenously injected methylprednisolone (40 mg/day). COPD assessment test (CAT), arterial blood gas analysis, hospitalization days, adverse effects, fasting blood glucose, serum creatinine, alanine aminotransferase levels, and blood drug were measured and analyzed in both groups.
RESULTS
Symptoms, pulmonary function and arterial blood gas analysis were significantly improved after treatment in both groups (P < 0.05), with no significant differences between them (P > 0.05), while incidence of adverse events in the budesonide group was lower (P < 0.05). No significant differences in CAT score, days of admission, blood gas analysis results and physiological and biochemical indexes were found between the two groups. Patients treated with methylprednisolone showed a higher degree of PaO2 level improvement.
CONCLUSION
Results show that inhalation of budesonide (2 mg 3 times/day) and systemic methylprednisolone (40 mg/day) had similar clinical outcome in AECOPD. In conclusion, inhaled budesonide is an alternative to systemic corticosteroids in AECOPD treatment.
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Additional Info
Disclosure statements are available on the authors' profiles:
A Randomized, Controlled Multicentric Study of Inhaled Budesonide and Intravenous Methylprednisolone in the Treatment on Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Respir Med 2016 Dec 01;121(xx)39-47, Z Ding, X Li, Y Lu, G Rong, R Yang, R Zhang, G Wang, X Wei, Y Ye, Z Qian, H Liu, D Zhu, R Zhou, K Zhu, R Ni, K Xia, N Luo, C PeiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Inhaled budesonide = IV methylprednisolone for acute COPD exacerbation
Acute exacerbations of COPD often require hospital admission for IV steroid treatment. This study shows that inhaled budesonide can be as effective with fewer side effects. A total of 410 patients with acute COPD exacerbations were randomized into two groups. The budesonide group was treated with nebulized budesonide (2 mg, three times/day) and the methylprednisolone group was treated with IV methylprednisolone (40 mg/day). Although the IV steroid group showed higher PaO2 levels, all other measures including FEV1 were similar. The degree of side effects was higher in the IV methylprednisolone group.
Although in this study both treatment groups were hospitalized, the findings may lead to the confidence to use nebulized budesonide to prevent admissions for acute COPD exacerbations if there is access to the primary care ICU…“I will see you tomorrow.”