Outcome of short-term systemic steroid therapy in chronic obstructive pulmonary disease patients with acute exacerbation

• Main Authors: Ashraf Zin El-Abdeen, Lamiaa H. Shaaban, Shereen Farghaly, Hanan Galal, Entsar H. Mohammed
• Format: Article
• Language: English
• Published: SpringerOpen 2018-08-01
• Series: The Egyptian Journal of Bronchology
• Subjects: acute exacerbation of chronic obstructive pulmonary disease; chronic obstructive pulmonary disease; short-term systemic steroid
• Online Access: http://link.springer.com/article/10.4103/ejb.ejb_104_17

Abstract Background There are insufficient data on the optimum duration of systemic steroid therapy during acute exacerbation of chronic obstructive pulmonary disease (COPD). Aim To 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 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 and the patients were classified into treatment success group or failure group. Results Treatment 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. Conclusion Most 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.