Department of Respiratory Medicine, Peking University Third Hospital, Beijing, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2020 Sep 30;15:2343-2353. doi: 10.2147/COPD.S255475. eCollection 2020.
Although corticosteroids have been widely used in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD), few studies have evaluated the effectiveness of nebulized corticosteroids (NCS), systemic corticosteroids (SCS), and NCS plus SCS in the management of AECOPD in China. This study aimed to evaluate the effectiveness of NCS, SCS, and NCS plus SCS in Chinese patients with AECOPD.
This was a real-world study of AECOPD patients at 43 sites from January to September 2014. During hospitalization, patients treated with nebulized budesonide (NCS group, n=1091), SCS (SCS group, n=709), or both (NCS+SCS group, n=1846) were included. Propensity score matching (PSM) and subgroup analyses were performed. The primary outcomes were the length of hospital stay, mortality, and change in arterial blood gases from baseline.
Multivariable analysis showed that the three treatments at the same severity of AECOPD were not significantly different regarding intubation rates, rates of pneumonia improvement at discharge, rates of new-onset pneumonia in hospital, and mortality. Following PSM, NCS+SCS was associated with greater length of hospital stay than both NCS and SCS (in patients without respiratory failure [RF, <0.001] and with type I RF [=0.022]), and more hospitalization costs than the other two treatments (in patients without RF [<0.001]).
NCS is effective for patients with AECOPD, which may be an alternative treatment option. Further clinical trials are urgently needed to better understand the efficacy of NCS, SCS, and NCS+SCS in AECOPD management in China.
尽管皮质类固醇已广泛用于治疗慢性阻塞性肺疾病急性加重（AECOPD），但很少有研究评估在中国人群中雾化皮质类固醇（NCS）、全身皮质类固醇（SCS）以及 NCS 加 SCS 治疗 AECOPD 的疗效。本研究旨在评估 NCS、SCS 以及 NCS 加 SCS 在中国 AECOPD 患者中的疗效。
这是一项 2014 年 1 月至 9 月在 43 个地点进行的 AECOPD 患者的真实世界研究。住院期间，接受布地奈德雾化吸入（NCS 组，n=1091）、SCS（SCS 组，n=709）或两者联合治疗（NCS+SCS 组，n=1846）的患者纳入研究。采用倾向评分匹配（PSM）和亚组分析。主要结局为住院时间、死亡率和动脉血气从基线的变化。
多变量分析显示，在同一严重程度的 AECOPD 患者中，三种治疗方法在气管插管率、出院时肺炎改善率、住院期间新发肺炎率和死亡率方面无显著差异。PSM 后，与 NCS 和 SCS 相比，NCS+SCS 在无呼吸衰竭（RF，<0.001）和 I 型 RF 患者（=0.022）中与更长的住院时间相关，与其他两种治疗方法相比，在无 RF 患者中（<0.001）住院费用更高。
NCS 对 AECOPD 患者有效，可能是一种替代治疗选择。迫切需要开展进一步的临床试验，以更好地了解 NCS、SCS 和 NCS+SCS 在中国 AECOPD 管理中的疗效。
