Department of Pharmacy Practice, School of Pharmacy, Lake Erie College of Osteopathic Medicine-Bradenton, Bradenton, FL 34211, USA.
Am J Health Syst Pharm. 2010 Jul 1;67(13):1061-9. doi: 10.2146/ajhp090293.
The literature was reviewed to determine whether data support current treatment guideline recommendations regarding the use of systemic corticosteroids in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations.
Exacerbations of COPD are common and can be detrimental to both patient health and health care costs. Corticosteroids are recommended by consensus guidelines for patients during exacerbations of COPD. Although guidelines make very specific recommendations, clinical data are conflicting and inconsistent. A search of the English-language medical literature was performed, and all randomized, double-blind, placebo-controlled trials or meta-analyses that examined the use of systemic corticosteroids in COPD exacerbations were included. Trials that included nebulized corticosteroids were also included as long as they were compared to a systemic corticosteroid and a placebo. Recommendations regarding the use of systemic corticosteroids are not optimal or completely supported. Data support recommendations if patients are treated on an outpatient basis. However, hospitalized patients might also benefit from higher doses of systemic steroids initially, followed by an oral taper dose.
In the treatment of COPD exacerbations, systemic corticosteroids improve airflow limitations, decrease treatment failure rates, decrease the risk of relapse, and may improve symptoms and decrease the length of hospital stay. Because of the risks of adverse effects, the lowest dose and shortest duration of corticosteroid therapy that will provide therapeutic benefit should be chosen. The literature suggests that hospitalized patients should benefit from a higher initial dosage of systemic corticosteroids than the 30-40 mg of i.v. or oral prednisolone for 7-10 days recommended in current guidelines.
本文旨在回顾文献，以确定目前关于全身皮质类固醇治疗慢性阻塞性肺疾病（COPD）加重的治疗指南建议是否有数据支持。
COPD 加重很常见，会对患者健康和医疗保健成本造成不利影响。皮质类固醇是共识指南推荐给 COPD 加重患者的药物。虽然指南有非常具体的建议，但临床数据存在冲突和不一致。我们对英文医学文献进行了检索，纳入了所有评估全身皮质类固醇治疗 COPD 加重的随机、双盲、安慰剂对照试验或荟萃分析。只要与全身皮质类固醇和安慰剂进行比较，也纳入了使用雾化皮质类固醇的试验。关于使用全身皮质类固醇的建议并不理想或完全得到支持。如果患者接受门诊治疗，数据支持这些建议。然而，住院患者最初可能也会受益于更高剂量的全身类固醇，然后口服逐渐减量。
在 COPD 加重的治疗中，全身皮质类固醇可改善气流受限，降低治疗失败率，降低复发风险，并可能改善症状和缩短住院时间。由于存在不良反应的风险，应选择提供治疗益处的最低剂量和最短疗程的皮质类固醇治疗。文献表明，与当前指南推荐的静脉或口服泼尼松龙 30-40mg 治疗 7-10 天相比，住院患者可能会从更高的初始全身皮质类固醇剂量中获益。
