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Arch Bronconeumol. 2017 Nov;53(11):611-615. doi: 10.1016/j.arbres.2017.03.012. Epub 2017 Apr 29.

Treatment With Systemic Steroids in Severe Chronic Obstructive Pulmonary Disease Exacerbations: Use of Short Regimens in Routine Clinical Practice and Their Impact on Hospital Stay.

[Article in English, Spanish]

Author information

1
Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España. Electronic address: pedro.jorge.marcos.rodriguez@sergas.es.
2
Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España.
3
Servicio de Neumología, Institut Clínic del Tòrax Hospital Clínic-IDIBAPS CIBER de Respiratorio, Universidad de Barcelona, Barcelona, España.
4
Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España.
5
Servicio de Medicina Interna, Instituto de Investigación Biomédica de A Coruña (INIBIC) Complejo Hospitalario Universitario de A Coruña (CHUAC) Sergas Universidade da Coruña (UDC), As Xubias, A Coruña, España.

Abstract

INTRODUCTION:

It is not known whether clinical practice guidelines for the treatment of COPD exacerbations with short coursesofsystemic corticosteroids(SC-SCS) are followed in clinical practice.

METHOD:

Prospective, observational cohort study in patients admitted due to severe COPD exacerbation. The primary endpoint was the percentage of patients who received SC-SCS as treatment for severe exacerbation (doses of 200-300mg for 5-6 days). Secondary variables were percentageof patients with duration or reduced dose, dose in the first 24hours, days of intravenous systemic corticosteroids (SCS), and duration of hospital length of stay (LOS). Simple linear regression was performed with LOS as a dependent variable and multivariate analysis with factors associated with LOS.

RESULTS:

158 patients were evaluated. 4.4% (7) patients received SC-SCS, 8.7% received a reduced dose and duration was reduced in 15.8%. The median dose and duration of SCS were 602.5mg (200-1625) and 14 (4-36) days, respectively. We observed an association between days of SCSand LOS (P<.001) and doses of intrahospitalSCSand LOS (P<.001). Factors associated with LOS were doses of intrahospitalSCS received (.01 [95% CI:.007-.013]; P<0.001), days of steroid treatment (.14 [95% CI .03-.25], P=.009) and PAFI (pO2/FiO2 ratio) at admission (-.012 [95% CI: -.012 to -.002], P=.015).

CONCLUSIONS:

The SCS schedules used in routine clinical practice are longer and administered at a higher dose than recommended, leading toa longer hospital stay.

KEYWORDS:

Agudización; Chronic obstructive pulmonary disease; Enfermedad pulmonar obstructiva crónica; Estancia hospitalaria; Esteroides; Exacerbation; Hospitalización; Hospitalization; Length of hospital stay; Steroids

PMID:
28461091
DOI:
10.1016/j.arbres.2017.03.012
[Indexed for MEDLINE]
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