Vondracek Sheryl F, Hemstreet Brian A
Department of Clinical Pharmacy, University of Colorado Health Sciences Center, 4200 E. Ninth Avenue, Denver, CO 80262, USA.
Am J Health Syst Pharm. 2006 Apr 1;63(7):645-52. doi: 10.2146/ajhp050316.
The use of systemic corticosteroids for the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was studied.
Medical charts of patients admitted to the hospital between July 2002 and November 2003 with a primary diagnosis of AECOPD were retrospectively reviewed. The primary objective was to characterize the drug, dosage, route, frequency, and duration of systemic corticosteroids prescribed for the management of AECOPD. The secondary objective was to compare the mean length of stay (LOS) and 30-day relapse rate between patients who received lower and higher dosages of corticosteroids.
One hundred forty-five admissions (123 patients) for AECOPD (mean +/- S.D. age, 65 +/- 11 years) were evaluated. Higher dosages of systemic corticosteroids (>80 mg of prednisone equivalent [PE] per day) were prescribed for 51% and i.v. therapy for 56% of admissions. The mean +/- S.D. total systemic corticosteroid exposure during hospitalization for all admissions was 759 +/- 971 mg of PE (mean +/- S.D. daily exposure = 134 +/- 111 mg of PE per day). The mean LOS was significantly longer for the higher-dosage group than for the lower-dosage group (6.1 versus 4.2 days, p = 0.0004). A tapered regimen was prescribed for 79% of discharges. Twenty-seven percent of the discharges with routine follow-up care had a relapse of disease within 30 days.
This retrospective observational study confirmed a wide variability in the dosages of systemic corticosteroids for the inpatient management of AECOPD, including the use of higher dosages and tapered regimens. Prospective randomized studies are needed to determine the most effective regimen of systemic corticosteroids in patients with AECOPD.
研究全身用糖皮质激素在慢性阻塞性肺疾病急性加重期（AECOPD）治疗中的应用。
回顾性分析2002年7月至2003年11月期间因AECOPD入院且以其为主要诊断的患者的病历。主要目的是描述用于AECOPD治疗的全身用糖皮质激素的药物、剂量、给药途径、频率和疗程。次要目的是比较接受低剂量和高剂量糖皮质激素治疗的患者的平均住院时间（LOS）和30天复发率。
对145例AECOPD住院病例（123例患者，平均年龄±标准差为65±11岁）进行了评估。51%的病例使用了较高剂量的全身用糖皮质激素（>80 mg泼尼松等效剂量[PE]/天），56%的病例采用静脉治疗。所有住院病例住院期间全身用糖皮质激素的平均总暴露量±标准差为759±971 mg PE（平均±标准差每日暴露量=134±111 mg PE/天）。高剂量组的平均住院时间显著长于低剂量组（6.1天对4.2天，p = 0.0004）。79%的出院病例采用了逐渐减量方案。在接受常规随访的出院病例中，27%在30天内疾病复发。
这项回顾性观察性研究证实，在AECOPD住院治疗中，全身用糖皮质激素的剂量存在很大差异，包括高剂量的使用和逐渐减量方案。需要进行前瞻性随机研究以确定AECOPD患者全身用糖皮质激素的最有效方案。
