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Eur J Endocrinol. 2015 Jul;173(1):19-27. doi: 10.1530/EJE-15-0182. Epub 2015 Apr 8.

Prospective analysis of adrenal function in patients with acute exacerbations of COPD: the Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial.

Author information

1
Department of EndocrinologyDiabetology, and Metabolism, Medical University Clinic, Kantonsspital, Tellstrasse H7, CH-5001 Aarau, SwitzerlandMedical University ClinicKantonsspital Baselland, CH-4410 Liestal, SwitzerlandInterdisciplinary Emergency DepartmentBasel Institute for Clinical Epidemiology and BiostatisticsClinic of EndocrinologyDiabetology, and Metabolism, University Hospital, CH-4031 Basel, SwitzerlandDepartment of Internal MedicineKantonsspital, CH-6000 Luzern 16, SwitzerlandDepartment of MedicineClinic of Internal Medicine, Hospital Center, CH-2501 Biel-Bienne, SwitzerlandClinic of Internal MedicineUniversity Hospital, CH-4013 Basel, SwitzerlandClinic of PneumologyUniversity Hospital, Petersgraben 4, CH-4031 Basel, SwitzerlandSwiss Tropical and Public Health InstituteUniversity of Basel, Socinstrasse 57, CH-4051 Basel, SwitzerlandArthritis Research UK Epidemiology UnitManchester Academic Health Science Center, The University of Manchester, Manchester, UKRespiratory Medicine ClinicUniversity Hospital Bern, Inselspital, CH-3010 Bern, SwitzerlandMedical University ClinicKantonsspital Baselland, CH-4101 Bruderholz, SwitzerlandBiozentrumKlingelbergstrasse 50/70, University of Basel, CH-4056 Basel, SwitzerlandDepartment of Clinical Epidemiology and BiostatisticsMcMaster University, Hamilton, Ontario, Canada.
2
Department of EndocrinologyDiabetology, and Metabolism, Medical University Clinic, Kantonsspital, Tellstrasse H7, CH-5001 Aarau, SwitzerlandMedical University ClinicKantonsspital Baselland, CH-4410 Liestal, SwitzerlandInterdisciplinary Emergency DepartmentBasel Institute for Clinical Epidemiology and BiostatisticsClinic of EndocrinologyDiabetology, and Metabolism, University Hospital, CH-4031 Basel, SwitzerlandDepartment of Internal MedicineKantonsspital, CH-6000 Luzern 16, SwitzerlandDepartment of MedicineClinic of Internal Medicine, Hospital Center, CH-2501 Biel-Bienne, SwitzerlandClinic of Internal MedicineUniversity Hospital, CH-4013 Basel, SwitzerlandClinic of PneumologyUniversity Hospital, Petersgraben 4, CH-4031 Basel, SwitzerlandSwiss Tropical and Public Health InstituteUniversity of Basel, Socinstrasse 57, CH-4051 Basel, SwitzerlandArthritis Research UK Epidemiology UnitManchester Academic Health Science Center, The University of Manchester, Manchester, UKRespiratory Medicine ClinicUniversity Hospital Bern, Inselspital, CH-3010 Bern, SwitzerlandMedical University ClinicKantonsspital Baselland, CH-4101 Bruderholz, SwitzerlandBiozentrumKlingelbergstrasse 50/70, University of Basel, CH-4056 Basel, SwitzerlandDepartment of Clinical Epidemiology and BiostatisticsMcMaster University, Hamilton, Ontario, Canada Department of EndocrinologyDiabetology, and Metabolism, Medical University Clinic, Kantonsspital, Tellstrasse H7, CH-5001 Aarau, SwitzerlandMedical University ClinicKantonsspital Baselland, CH-4410 Liestal, SwitzerlandInterdisciplinary Emergency DepartmentBasel Institute for Clinical Epidemiology and BiostatisticsClinic of EndocrinologyDiabetology, and Metabolism, University Hospital, CH-4031 Basel, SwitzerlandDepartment of Internal MedicineKantonsspital, CH-6000 Luzern 16, SwitzerlandDepartment of MedicineClinic of Internal Medicine, Hospital Center, CH-2501 Biel-Bienne, SwitzerlandClinic of Internal MedicineUniversity Hospital, CH-4013 Basel, SwitzerlandCl

Abstract

OBJECTIVE:

To analyze prospectively the hypothalamic-pituitary-adrenal (HPA) axis and clinical outcome in patients treated with prednisone for exacerbated chronic obstructive pulmonary disease (COPD).

DESIGN:

Prospective observational study.

SUBJECTS AND METHODS:

Patients presenting to the emergency department were randomized to receive 40 mg prednisone daily for 5 or 14 days in a placebo-controlled manner. The HPA axis was longitudinally assessed with the 1 μg corticotropin test and a clinical hypocortisolism score at baseline, on day 6 before blinded treatment, at hospital discharge, and for up to 180 days of follow-up. Prednisone was stopped abruptly, irrespective of the test results. Patients discharged with pathological test results received instructions about emergency hydrocortisone treatment.

RESULTS:

A total of 311 patients were included in the analysis. Mean basal and stimulated serum total cortisol levels were highest on admission (496±398 and 816±413 nmol/l respectively) and lowest on day 6 (235±174 and 453±178 nmol/l respectively). Pathological stimulation tests were found in 63, 38, 9, 3, and 2% of patients on day 6, at discharge, and on days 30, 90, and 180 respectively, without significant difference between treatment groups. Clinical indicators of hypocortisolism did not correlate with stimulation test results, but cortisol levels were inversely associated with re-exacerbation risk. There were no hospitalizations or deaths as a result of adrenal crisis.

CONCLUSION:

Dynamic changes in the HPA axis occur during and after the treatment of acute exacerbations of COPD. In hypocortisolemic patients who were provided with instructions about stress prophylaxis, the abrupt termination of prednisone appeared safe.

PMID:
25855628
DOI:
10.1530/EJE-15-0182
[Indexed for MEDLINE]

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