Revista Facultad de Medicina de la Universidad Nacional de Colombia
Print version ISSN 0120-0011
PEREZ-MONROY¹, Ariel; CAMARGO, Juan Pablo and JUNCA, Alejandro. Comparison of steroids use in conventional management of exacerbations of chronic obstructive pulmonary disease. Rev.fac.med.unal [online]. 2010, vol.58, n.1, pp. 15-29. ISSN 0120-0011.
Background. Chronic obstructive pulmonary disease is a common condition characterized by limited chronic, progressive and irreversible airflow that affects 52 million people worldwide. Objective. To compare two different steroid schemes with current conventional treatment of non-acidotic acute exacerbations of chronic obstructive pulmonary disease. Materials and methods. The study was conducted in the Clínica Carlos Lleras Restrepo in Bogotá. A total of 106 patients diagnosed with exacerbated COPD were assigned to 3 treatment groups: a) conventional treatment, b) hydrocortisone and conventional treatment and c) prednisone and conventional treatment. After 72 hrs, the percentage of change in peak flow values, the variation in lung auscultation and the clinical perception of improvement were evaluated. The length of hospital stay, the need for additional treatments and mechanical ventilation, and the presence of side effects were recorded. Results. We did not find any significant differences in treatment outcomes between the three schemes, except for a greater perception of symptom improvement with hydrocortisone. In the subgroup analysis, oral prednisone shortened the length of hospital stay and improved the peak expiratory flow and the subjective perception of symptoms in patients over 80 years old, with a FEV1 < 50% of predicted, and a severe exacerbation. Sex, functional class, cause and type of exacerbation, number of exacerbations per year, and cumulative smoking history did not affect the treatment outcome. The most frequently reported side effect of steroid therapy was hyperglycemia. Conclusions. Systemic steroids were not superior to conventional therapy for COPD exacerbations. However, oral prednisone caused objective and subjective improvement in patients over 80 years old with severe exacerbations and in those with severe underlying disease.
Keywords : pulmonary disease, chronic obstructive (COPD); recurrence (exacerbation); adrenal cortex hormones.