Potential Quality Gaps in Use of Inhaled Corticosteroids Following Hospitalization for Acute COPD Exacerbation.

2009 ◽  
Author(s):  
RA Mularski ◽  
MA McBurnie ◽  
B Crane ◽  
JA Krishnan ◽  
DH Au ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Copd Exacerbation

Effectiveness and Safety Comparison for Systemic Corticosteroid Therapy With and Without Inhaled Corticosteroids for COPD Exacerbation Management

2018 ◽  
Vol 52 (11) ◽  
pp. 1070-1077 ◽  
Author(s):  
Jordan A. Pearce ◽  
Dane L. Shiltz ◽  
Qian Ding
Keyword(s):  
Corticosteroid Therapy ◽  
Systemic Corticosteroid ◽  
Inhaled Corticosteroids ◽  
Prospective Trial ◽  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Inpatient Setting ◽  
Copd Exacerbation ◽  
Significant Difference ◽  
Systemic Corticosteroid Therapy

Background: Only 1 small, single-center study has evaluated the combination of systemic plus inhaled corticosteroid (ICS) routes for chronic obstructive pulmonary disease (COPD) exacerbation management. This study aims to further improve the existing quantity and quality of evidence regarding the utility for combination therapy in the management of COPD exacerbation. Objectives: To evaluate length of hospital stay, readmission rate, incidence of infection, and mortality in hospitalized patients who experience a COPD exacerbation and receive systemic corticosteroid therapy with or without concurrent ICS. Methods: Design: retrospective cohort study. Participants and setting: patients at least 18 years old admitted between May 31, 2015, and May 31, 2016, for an acute COPD exacerbation at any of 7 Indiana University Health system hospitals. Interventions: patients who received an oral or intravenous systemic corticosteroid either with or without concurrent ICS therapy. Results: This study included 241 patients. No significant difference was found between rates of 30-day readmission or inpatient mortality. Patients receiving concurrent therapy had longer lengths of stay versus those who only received systemic corticosteroid therapy (6.35 ± 3.98 vs 4.99 ± 2.89 days, P = 0.0039). Differences in the rates of antifungal use and mechanical ventilation did not statistically differ. Conclusion and Relevance: There was no significant benefit demonstrated when adding ICS to systemic corticosteroid therapy for COPD exacerbation management. These preliminary findings build on the limited evidence on how best to manage corticosteroid therapy in the inpatient setting, but a large, prospective trial remains warranted to confirm these findings given the design, size, and concern for selection bias limitations in the present study.

scholarly journals Inhaled corticosteroid withdrawal may improve outcomes in elderly patients with COPD exacerbation: a nationwide database study

2020 ◽  
Vol 6 (1) ◽  
pp. 00246-2019 ◽  
Author(s):  
Taisuke Jo ◽  
Hideo Yasunaga ◽  
Yasuhiro Yamauchi ◽  
Akihisa Mitani ◽  
Yoshihisa Hiraishi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Bronchial Asthma ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Obstructive Pulmonary Disease ◽  
Inverse Probability ◽  
Propensity Score Matching Analysis

BackgroundInhaled corticosteroids (ICSs) are used for advanced-stage chronic obstructive pulmonary disease (COPD). The application and safety of ICS withdrawal remain controversial.This study aimed to evaluate the association between ICS withdrawal and outcomes in elderly patients with COPD with or without comorbid bronchial asthma, who were hospitalised for exacerbation.Patients and methodsWe conducted a retrospective cohort study using the Japanese Diagnosis Procedure Combination database from July 2010 to March 2016. We identified patients aged ≥65 years who were hospitalised for COPD exacerbation. Re-hospitalisation for COPD exacerbation or death, frequency of antimicrobial medicine prescriptions and frequency of oral corticosteroid prescriptions after discharge were compared between patients with withdrawal and continuation of ICSs using propensity score analyses, namely 1–2 propensity score matching and stabilised inverse probability of treatment weighting.ResultsAmong 3735 eligible patients, 971 and 2764 patients had ICS withdrawal and continuation, respectively. The hazard ratios (95% confidence intervals) of re-hospitalisation for COPD exacerbation or death for ICS withdrawal compared to continuation were 0.65 (0.52–0.80) in the propensity score matching and 0.71 (0.56–0.90) in the inverse probability of treatment weighting. The frequency of antimicrobial prescriptions but not corticosteroid prescriptions within 1 year was significantly less in the ICS withdrawal group. Among patients with comorbid bronchial asthma, ICS withdrawal was significantly associated with reduced re-hospitalisation for COPD exacerbation or death only in the propensity score matching analysis.ConclusionICS withdrawal after COPD exacerbation was significantly associated with reduced incidences of re-hospitalisation or death among elderly patients, including those with comorbid bronchial asthma.

scholarly journals Blood eosinophils: a biomarker of COPD exacerbation reduction with inhaled corticosteroids

2018 ◽  
Vol Volume 13 ◽  
pp. 3669-3676 ◽  
Author(s):  
Salman H Siddiqui ◽  
Ian D Pavord ◽  
Neil C Barnes ◽  
Alessandro Guasconi ◽  
Sally Lettis ◽  
...  
Keyword(s):  
Inhaled Corticosteroids ◽  
Copd Exacerbation ◽  
Blood Eosinophils

scholarly journals Peripheral Blood Eosinophils as Marker of Sputum Eosinophilia and Outcome of COPD Exacerbation

2019 ◽  
Vol 49 (1) ◽  
Author(s):  
Edin Jusufović ◽  
Mitja Kosnik ◽  
Jasmina Nurkić ◽  
Nermina Arifhodžić ◽  
Mona Al-Ahmad ◽  
...  
Keyword(s):  
Stable Disease ◽  
Peripheral Blood ◽  
Inhaled Corticosteroids ◽  
Positive Likelihood Ratio ◽  
Chronic Obstructive ◽  
Copd Exacerbation ◽  
Blood Eosinophilia ◽  
Sputum Eosinophilia ◽  
Sputum Eosinophils ◽  
Blood Eosinophils

Sputum eosinophils might predict response to inhaled corticosteroids (ICS) in patients with advanced chronic obstructive pulmonary disease (COPD). Induction of sputum requires expertise and may not always be successful. Aim was to investigate correlation and predictive relationship between peripheral blood eosinophils (bEo) and sputum eosinophils (sEo), and impact of peripheral blood eosinophilia on outcome of COPD exacerbation. 120 current smokers with COPD (GOLD group C) (57.4 ± 0.92 years, M/F ratio 1.4), with no blood (≥7% or >0.43x109/L) nor sputum (≥3%) eosinophilia, were treated with moderate dose of ICS and long-acting bronchodilatator during stable disease, but systemic corticosteroids and antibiotics during exacerbation. According to sputum eosinophilia (≥4%) during exacerbation, patients were divided into eosinophilic (n=45) and non-eosinophilic group (n=75). In stable disease, bEo and sEo were similar in both groups (p>0.05). During exacerbation, bEo and sEo were significantly higher in eosinophilic group (eosinophilic vs. non-eosinophilic: blood: 1.42 ± 0.39 x109/l vs. 0.23 ± 0.02 x109/l, p<0.001; sputum: 8% (4, 19) vs. 1% (0, 3), p<0.0001), but bEo correlated with sEo in both groups (eosinophilic: r=0.52, p<0.001; non-eosinophilic: r=0.25, p<0.05). Relative bEo predicted sputum eosinophilia (area under the curve=0.71, standard error=0.05; 95% confidence interval [CI] =0.61-0.81; p<0.001) and enabled identification of the presence or absence of sputum eosinophilia in 82% of the cases at a threshold of ≥4% (specificity=83.56%, sensitivity=93.83%, positive likelihood ratio=3.67). Eosinophilic group during exacerbation showed less frequent hospitalisations and shorter exacerbation (eosinophilic vs. non-eosinophilic: hospitalisations: 26.7% vs. 60.0%, p<0.001; duration of exacerbation (days): 8.1±0.35 vs. 10.13±0.31, p<0.0001). In COPD exacerbation, relative peripheral blood eosinophils ≥4% might identify sputum eosinophilia. Blood eosinophilia indicate better outcome of COPD exacerbation. Further investigations are needed to predict eosinophilic exacerbation in COPD patients, with prior absence of sputum or blood eosinophilia.

Tiotropium as add-on to inhaled corticosteroids significantly improves asthma control as reflected by the ACQ responder rate

Pneumologie ◽  
2014 ◽  
Vol 68 (S 01) ◽  
Author(s):  
O Schmidt ◽  
HAM Kerstjens ◽  
E Bleecker ◽  
E Meltzer ◽  
T Casale ◽  
...  
Keyword(s):  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Responder Rate
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