scholarly journals Evaluation of Corticosteroid Dose in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2017 ◽  
Vol 52 (8) ◽  
pp. 546-550 ◽  
Author(s):  
Alice N. Hemenway ◽  
Alexandra M. Terry
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Blood Glucose ◽  
Length Of Stay ◽  
Readmission Rate ◽  
Dose Group ◽  
Low Dose ◽  
Dose Range ◽  
Chronic Obstructive ◽  
High Dose ◽  
Obstructive Pulmonary Disease

Background: Several recent studies have shown that both lower doses and shorter durations of systemic corticosteroids have similar efficacy for treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, each trial has limitations that constrain direct applicability to a US hospital population. Objective: The aim of this study was to determine whether, in a US community hospital, low doses of corticosteroids provide the lowest risk of adverse effects without increasing length of stay or readmission rate. Methods: A single-center retrospective cohort was performed using patients meeting criteria for AECOPD. Primary endpoints included length of hospitalization, proportion of patients with >30% increase in blood glucose from baseline, and rate of 30-day readmission; multivariable regression analysis was used for comparison. The 3 inpatient cumulative dose range groups were low: ≤250-mg prednisone equivalents, medium: 251 to 500 mg, and high: ≥501 mg. Results: A total of 665 records were evaluated, with 369 records included. As the corticosteroid dose ranges increased, there were more patients with increased blood glucose (33.3%, 54.4%, 59.9%). When holding all other factors constant, there was a statistically significant increase in patients with elevated blood glucose with the medium- and high-dose groups as compared with the low-dose group ( P < .009, P < .001), the average length of stay was 21.3 hours higher in the high-dose group as compared with the low-dose group ( P < .001), and there were no significant differences in readmission rates between the dose groups. Conclusions: The lowest dose range of corticosteroids was associated with the lowest rate of impaired blood glucose without a statistically significant increase in length of stay or readmission rate.

Optimal glucocorticoid dose and the effects on mortality, length of stay, and readmission rates in patients diagnosed with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)

2019 ◽  
Vol 67 (8) ◽  
pp. 1161-1164
Author(s):  
Asim Kichloo ◽  
Michael Aljadah ◽  
Navya Vipparla ◽  
Farah Wani
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Low Dose ◽  
Future Research ◽  
Chronic Obstructive ◽  
High Dose ◽  
Readmission Rates ◽  
Glucocorticoid Treatment ◽  
Obstructive Pulmonary Disease

The burden of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is staggering on a national and global level. Yet, surprisingly, there is a profound lack of treatment standardization with glucocorticoids in the treatment of AECOPD. In this review, we bring attention to specific literature that use a cut-off of 60 mg prednisone equivalent per day when distinguishing between high-dose and low-dose glucocorticoid treatment. We hope this review encourages future research to begin incrementally lowering the cut-off dose of 60 mg to discover if mortality, length of hospital stays, and readmission rates change between high-dose and low-dose glucocorticoid treatment. The final hope would be to establish an optimal glucocorticoid dose to treat AECOPD and eliminate treatment ambiguity.

Invasive-noninvasive Sequential Ventilation for the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease

2019 ◽  
Vol 22 (3) ◽  
pp. 160-168
Author(s):  
Jian-Da Huang ◽  
Tong-Jie Gu ◽  
Zhi-Lin Hu ◽  
Dan-Fei Zhou ◽  
Jun Ying
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Relevant Literature ◽  
Total Duration ◽  
Chronic Obstructive ◽  
Invasive Ventilation ◽  
Obstructive Pulmonary Disease ◽  
Relative Risks

Background: The study aimed to evaluate the efficacy and safety of invasivenoninvasive sequential ventilation versus invasive ventilation in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Method: PubMed, Cochrane, Embase, Wanfang, CNKI, VIP database were searched by the index words to identify the qualified RCTs, and relevant literature sources were also searched. The latest research was conducted in June 2017. Relative Risks (RR), and Mean Difference (MD) along with 95% confidence interval (95% CI) were used to analyze the main outcomes. Result: Twenty-nine RCTs were involved in this analysis of 1061 patients in the invasivenoninvasive sequential ventilation group (In-non group) and 1074 patients in the invasive ventilation group (In group). The results indicated that compared with the invasive ventilation, invasive-noninvasive sequential ventilation would significantly decrease the incidence of VAP (RR:0.20, 95%CI: 0.16-0.26), mortality (RR:0.38, 95%CI: 0.26-0.55), reintubation (RR:0.39, 95%CI: 0.27-0.55); and statistically reduced the duration of invasive ventilation (MD:-9.23, 95%CI: -10.65, -7.82), the total duration of mechanical ventilation (MD:-4.91, 95%CI: -5.99, -3.83), and the length of stay in the ICU (MD:-5.10, 95%CI: -5.43, -4.76). Conclusion: The results demonstrated that the application of noninvasive sequential ventilation after invasive ventilation at the pulmonary infection control window has a significant influence on VAP incidence, mortality, and the length of stay in the ICU, but further well-designed, adequately powered RCTs are required to validate the conclusion.

scholarly journals Simultaneous Assessment of Airway Instability and Respiratory Dynamics with Low-Dose 4D-CT in Chronic Obstructive Pulmonary Disease: A Technical Note

Respiration ◽  
2014 ◽  
Vol 87 (4) ◽  
pp. 294-300 ◽  
Author(s):  
Mark O. Wielpütz ◽  
Ralf Eberhardt ◽  
Michael Puderbach ◽  
Oliver Weinheimer ◽  
Hans-Ulrich Kauczor ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Low Dose ◽  
Technical Note ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
4D Ct ◽  
Respiratory Dynamics ◽  
Simultaneous Assessment

The Effects of Oral Almitrine on Pattern of Breathing and Gas Exchange in Patients with Chronic Obstructive Pulmonary Disease

1984 ◽  
Vol 66 (4) ◽  
pp. 435-442 ◽  
Author(s):  
J. R. Stradling ◽  
C. G. Nicholl ◽  
D. Cover ◽  
E. E. Davies ◽  
J. M. B. Hughes ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Gas Exchange ◽  
Pulmonary Disease ◽  
Low Dose ◽  
Statistical Significance ◽  
Chronic Obstructive ◽  
Inspiratory Flow Rate ◽  
Obstructive Pulmonary Disease ◽  
Oxygen Breathing ◽  
Arterial Po2

1. Almitrine at a low dose of 100 mg orally significantly raises Pao2 and lowers Paco2 in patients with chronic obstructive pulmonary disease, compared with placebo, when they were breathing air or 28% oxygen. 2. The estimated ideal alveolar — arterial Po2 difference was less after almitrine compared with placebo, when patients were breathing either air or 28% oxygen. 3. After almitrine overall ventilation breathing air increased by 10% but this did not reach statistical significance. During 28% oxygen breathing almitrine hardly altered overall ventilation but the inspiratory duty cycle (Ti/Ttot.) decreased and mean inspiratory flow rate (VT/Ti) increased compared with placebo. These changes were significant on a paired t-test (P<0.05). 4. Changes in both volume and pattern of breathing may explain the improved gas exchange in the lung after almitrine.

scholarly journals COVID-19 health inequities and association with mechanical ventilation and prolonged length of stay at an urban safety-net health system in Chicago

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258243
Author(s):  
Jacquelyn Jacobs ◽  
Amy K. Johnson ◽  
Arianna Boshara ◽  
Bijou Hunt ◽  
Christina Khouri ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Safety Net ◽  
Chronic Obstructive ◽  
Minority Population ◽  
Obstructive Pulmonary Disease ◽  
Ethnic Minority Population ◽  
Prolonged Length

Millions of Americans have been infected with COVID-19 and communities of color have been disproportionately burdened. We investigated the relationship between demographic characteristics and COVID-19 positivity, and comorbidities and severe COVID-19 illness (use of mechanical ventilation and length of stay) within a racial/ethnic minority population. Patients tested for COVID-19 between March 2020 and January 2021 (N = 14171) were 49.9% (n = 7072) female; 50.1% (n = 7104) non-Hispanic Black; 33.2% (n = 4698) Hispanic; and 23.6% (n = 3348) aged 65+. Overall COVID-19 positivity was 16.1% (n = 2286). Compared to females, males were 1.1 times more likely to test positive (p = 0.014). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic persons were 1.4 (p = 0.003) and 2.4 (p<0.001) times more likely, respectively, to test positive. Compared to persons ages 18–24, the odds of testing positive were statistically significantly higher for every age group except 25–34, and those aged 65+ were 2.8 times more likely to test positive (p<0.001). Adjusted for race, sex, and age, COVID-positive patients with chronic obstructive pulmonary disease were 1.9 times more likely to require a ventilator compared to those without chronic obstructive pulmonary disease (p = 0.001). Length of stay was not statistically significantly associated with any of the comorbidity variables. Our findings emphasize the importance of documenting COVID-19 disparities in marginalized populations.

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