Alshehri Samah, Alalawi Mai, Makeen Abdulrahman, Jad Ammar, Alhuwaysi Ahmed, Alageeli Mohammed, Alshibani Mohannad
Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.
Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Malays J Med Sci. 2021 Feb;28(1):59-65. doi: 10.21315/mjms2021.28.1.8. Epub 2021 Feb 24.
The administration of systemic corticosteroids in chronic obstructive pulmonary disease (COPD) exacerbation is the first line of management. The duration of this administration, however, is not well established in clinical practice. The objective of this study is to compare the clinical outcomes between short-term and long-term corticosteroid use in the acute exacerbation of COPD patients.
A single-centre, retrospective cohort study was conducted. From 2014 to 2018, all patients over 40 years old with COPD who were admitted to the hospital with a case of COPD exacerbation and received systemic corticosteroids at presentation were included. The subjects were divided into two groups according to the duration of systemic corticosteroid therapy. The primary outcome was hospital re-admission within 180 days. The secondary outcomes were 30 days mortality and length of hospitalisation. The two groups were compared using an independent sample -test, a Chi-square test, and a Mann-Whitney U test, according to the data type.
Eighty patients met the inclusion criteria. A total of 52 (65%) patients completed long-term therapy, while 28 (35%) patients were on short-term treatment. A total of 15 (28.8%) patients reached the primary endpoint in the long-term treatment group versus 19 (67.9%) in the short-term treatment group ( = 0.001). The 30-day mortality was 4 (7.7%) and 0 (0%), respectively, and the median length of hospitalisation was 6.5 and 7.5 days in the long-term group and short-term group, respectively ( = 0.32, = 0.88).
Long-term corticosteroid use in the management of acute COPD exacerbation was significantly associated with fewer 180 days re-admission. The duration of corticosteroid use remains controversial, and further studies are recommended to assess the relationship between patient profile and adherence to therapy post-discharge with re-exacerbation.
在慢性阻塞性肺疾病（COPD）急性加重期应用全身性糖皮质激素是一线治疗方法。然而，这种治疗的持续时间在临床实践中尚未明确确立。本研究的目的是比较COPD患者急性加重期短期和长期使用糖皮质激素的临床结局。
进行了一项单中心回顾性队列研究。纳入2014年至2018年所有40岁以上因COPD急性加重入院且就诊时接受全身性糖皮质激素治疗的COPD患者。根据全身性糖皮质激素治疗的持续时间将受试者分为两组。主要结局是180天内再次入院。次要结局是30天死亡率和住院时间。根据数据类型，使用独立样本t检验、卡方检验和曼-惠特尼U检验对两组进行比较。
80例患者符合纳入标准。共有52例（65%）患者完成长期治疗，28例（35%）患者接受短期治疗。长期治疗组共有15例（28.8%）患者达到主要终点，而短期治疗组为19例（67.9%）（P = 0.001）。30天死亡率分别为4例（7.7%）和0例（0%），长期组和短期组的住院中位时间分别为6.5天和7.5天（P = 0.32，P = 0.88）。
在急性COPD加重期的治疗中，长期使用糖皮质激素与180天内再次入院次数减少显著相关。糖皮质激素的使用持续时间仍存在争议，建议进一步研究以评估患者特征与出院后治疗依从性及再次加重之间的关系。
