Department of Respiratory Medicine, Peking University Third Hospital, Beijing, China.
State Key Laboratory of Respiratory Disease, National Clinical Research Center, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Ther Adv Respir Dis. 2018 Jan-Dec;12:1753466618769514. doi: 10.1177/1753466618769514.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are common in patients with underlying moderate to severe COPD and are associated with increased health and economic burden. International and Chinese guidelines recommend using glucocorticoids for the management of AECOPD because glucocorticoid therapy has been shown to benefit clinical outcomes. However, only scant data are available for current status of glucocorticoid therapy in hospitalized AECOPD patients in China. The aim of the study was to identify current use of glucocorticoids for the treatment of AECOPD in China.
This retrospective, multicenter, noninterventional study evaluated the treatment pattern of AECOPD in patients hospitalized from January 2014 to September 2014 at 43 sites (41 tertiary hospitals and two secondary hospitals) in China. The endpoints of the study were the percentage of patients receiving glucocorticoids by different routes of administration, doses and duration, mortality, and the mean length of hospitalization.
A total of 4569 patients (90.17%) received glucocorticoids for AECOPD treatment. A combination of nebulized and systemic route was most frequently used (40.51%), followed by using nebulized route alone (38.00%), systemic route alone (15.45%), and inhaled route other than nebulization (6.04%). Furthermore, the most commonly prescribed glucocorticoids of the nebulized, intravenous, inhaled (other than nebulized) and oral route was budesonide (69.4%), methylprednisolone sodium succinate (45.31%), fluticasone propionate (19.54%), and prednisone acetate (11.90%), respectively. The in-hospital mortality rate was 1.24% and the mean length of hospitalization was 12.22 ± 6.20 days (± SD).
Our study was the first study of the treatment pattern of glucocorticoids in the management of hospitalized AECOPD patients in China. Data indicates that there is a gap in the implementation of international guidelines for the treatment of AECOPD in China. Further studies are warranted to clarify the appropriate glucocorticoids strategy for the management of AECOPD to determine the optimal route of administration, dose and duration, and resulting clinical outcomes.
慢性阻塞性肺疾病（COPD）急性加重（AECOPD）在中重度 COPD 患者中很常见，会增加健康和经济负担。国际和中国的指南都建议使用糖皮质激素治疗 AECOPD，因为糖皮质激素治疗已被证明有益于临床结局。然而，目前在中国住院 AECOPD 患者中糖皮质激素治疗的现状仅有少量数据。本研究旨在确定中国住院 AECOPD 患者中糖皮质激素的治疗现状。
这是一项回顾性、多中心、非干预性研究，评估了 2014 年 1 月至 2014 年 9 月期间在中国 43 个地点（41 家三级医院和 2 家二级医院）住院的 AECOPD 患者的治疗模式。该研究的终点是接受不同给药途径、剂量和时间的糖皮质激素治疗的患者比例、死亡率和平均住院时间。
共有 4569 例（90.17%）患者因 AECOPD 接受糖皮质激素治疗。最常使用的是联合雾化和全身途径（40.51%），其次是单独雾化途径（38.00%）、单独全身途径（15.45%）和非雾化吸入途径（6.04%）。此外，雾化、静脉、吸入（非雾化）和口服途径最常使用的糖皮质激素分别为布地奈德（69.4%）、甲泼尼龙琥珀酸钠（45.31%）、丙酸氟替卡松（19.54%）和醋酸泼尼松龙（11.90%）。住院死亡率为 1.24%，平均住院时间为 12.22±6.20 天（±SD）。
本研究是中国首次研究住院 AECOPD 患者糖皮质激素治疗模式的研究。数据表明，中国在 AECOPD 治疗方面实施国际指南存在差距。需要进一步研究来阐明 AECOPD 管理中糖皮质激素的适当治疗策略，以确定最佳给药途径、剂量和时间以及由此产生的临床结局。
