Chronic Obstructive Pulmonary Disease Clinical Trial
Official title:
The Therapeutic Impact of Various Doses of Systemic Steroid in Acute Exacerbation of Chronic Obstructive Pulmonary Disease
It is well established that steroid use is a benefit in the treatment of chronic obstructive pulmonary disease (COPD) with acute exacerbation (AE). But it is still debated about the regimen and dosage of steroid use. From this retrospective review of medical charts, the researchers investigated the therapeutic impact of various steroid dosages in COPD with AE.
Data collection from medical charts was conducted at Far Eastern Memorial Hospital, a
tertiary-care hospital with around 900 beds. Patients who were admitted from January 2008 to
December 2008 and diagnosed as having chronic obstructive pulmonary disease with acute
exacerbation (code ICD-9: 491.21) were included in this study. The study was approved by the
Institutional Review Board of the Far Eastern Memorial Hospital (FEMH:098097-3).
Demographic data, medical histories and medicine prescriptions at outpatient clinics,
emergency and inpatient departments were collected. The initial presentations of acute
exacerbation and laboratory data were also summarized from the records of the emergency
department. The reports of pulmonary function tests within 6 months before or after the
exacerbations were included while reviewing the charts. The probability of concomitant
pneumonia (pAECOPD) was determined by attending physicians and reviewed by the investigator
according to the radiologic findings. If there were incoherent opinions about the
probability of pneumonia between the physicians and the investigator, it was determined by
another independent pulmonologist. The highest daily doses and total doses of systemic
steroids were calculated and recorded as the equivalent doses of prednisolone (1 mg
methylprednisolone is equal to 1.25 mg prednisolone; 1 mg hydrocortisone is equal to 0.25 mg
prednisolone). The subjects were divided into 3 groups according to the highest daily dose
of steroids as follows: patients receiving more than 60 mg/day were designated to the HD
group; those receiving less than or equal to 60 mg/day to the LD group; and those who did
not receive any steroids during admission to the NIL group. The length of stay (LOS) was
defined as the duration from admission to the emergency department to discharge.
Hyperglycemia, psychosis, nosocomial infections and active peptic ulcer diseases were
regarded as acute side effects of systemic steroids. Hyperglycemia was defined as a new
blood sugar level of more than 200 mg/dl in patients without a history of diabetic mellitus,
or an increment in diabetes medications. The relapse rate within 30 days was assessed by
outpatient follow-up records.
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Observational Model: Cohort, Time Perspective: Retrospective
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