Corticosteroid Exposure in the Treatment of Severe COPD Exacerbations

Background: Recent literature and guidelines support treatment of severe acute exacerbation of COPD (AECOPD) with prednisone 40 mg (or equivalent) for 5 days. Objective: The purpose of this study was to determine whether systemic corticosteroids were being prescribed at the appropriate dose and duration in the treatment of severe AECOPD at a large academic medical institution. Methods: This was a single-center, retrospective, observational study conducted to evaluate corticosteroid prescribing patterns for adults admitted for severe AECOPD from March to May 2019 at a large academic medical institution. Appropriate therapy was defined as: prednisone 40 mg (or equivalent) for 5 days. The primary outcome was to determine the frequency of appropriate dose and duration. The secondary outcomes were to identify the frequency of appropriate dose or duration, compare the prevalence of adverse effects, such as new/worsening hyperglycemia or hypertension, and compare 30- and 90-day readmission rates. Results: Of the 190 patients included, 16 (8.4%) had an appropriate duration and 8 (4.2%) an appropriate dose. Only 4 patients (2.1%) had both appropriate corticosteroid dose and duration. New/worsening hyperglycemia occurred in 96 (50.5%), and hypertension developed in 13 (6.8%). Thirty-day readmission occurred in 46 (24.2%) and 90-day readmission in 78 (41.1%). These were more likely in those without appropriate dose and duration. Conclusion: Systemic corticosteroids for the treatment of severe AECOPD are not prescribed in accordance with evidence-based recommendations at this institution. This might result in a greater incidence of adverse effects and readmissions.

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Review: ≤ 7 and > 7 days of systemic corticosteroids do not differ for efficacy in COPD exacerbations

Annals of Internal Medicine ◽

10.7326/acpjc-2015-162-6-007 ◽

2015 ◽

Vol 162 (6) ◽

pp. JC7

Author(s):

Paul Jones

Keyword(s):

Copd Exacerbations ◽

Systemic Corticosteroids

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Characteristics and Causes for Non-Accrued Clinical Research (NACR) at an Academic Medical Institution

Journal of Clinical Medicine Research ◽

10.4021/jocmr1320w ◽

2013 ◽

Cited By ~ 1

Author(s):

Tice

Keyword(s):

Clinical Research ◽

Medical Institution ◽

Academic Medical

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(118) Development of a clinical outcomes database for spine pain within an academic medical institution

Journal of Pain ◽

10.1016/j.jpain.2014.01.024 ◽

2014 ◽

Vol 15 (4) ◽

pp. S5

Author(s):

W. Rivers ◽

B. Mead ◽

K. Gosselin ◽

K. Vowles

Keyword(s):

Clinical Outcomes ◽

Medical Institution ◽

Spine Pain ◽

Academic Medical

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INFLUENCE OF OZONE THERAPY ON THE DYNAMICS OF HUMORAL IMMUNITY INDEXESIN OBSERVATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Farmaciâ Kazahstana ◽

10.53511/pharmkaz.2021.58.80.013 ◽

2021 ◽

pp. 60-64

Author(s):

А. М. ЖУКЕМБАЕВА ◽

К.С. ЛАТКИНА ◽

К. М. КАПАРОВА ◽

А.К. КУАТ ◽

Ж. К. АТХАН ◽

...

Keyword(s):

Personal Data ◽

Chronic Obstructive ◽

Ozone Therapy ◽

Immunological Parameters ◽

Study Program ◽

Obstructive Pulmonary Disease ◽

Copd Exacerbations ◽

Group I ◽

Group Ii ◽

Exacerbation Of Copd

Проведен анализ результатов изменений иммунологических показателей на фоне проводимого лечения обострения ХОБЛ, проведенного у 55 больных. Все больные, рассматриваемые в нашей работе, подписали письменное информированное согласие на участие в программе исследований и неразглашении личных данных. Установлено, что через 7 суток после начала лечения уровень IgM в сыворотке крови во II группе, где проводилась озонотерапия, был достоверно меньше, чем в I, что свидетельствовало о более быстрой регрессии воспалительного процесса во II группе (P< 0,05). При этом показатели HCT-индуцированного фагоцитоза, на фоне проводимой озонотерапии во II группе, были достоверно больше, чем в I, где озонотерапия не проводилась (P<0,05). То есть, резервы кислород зависимой фагоцитарной активности нейтрофилов во II группе на фоне проведения озонотерапии были более функционально активны. Особого внимания заслуживает то, что во II группе элиминация ЦИК происходила достоверно быстрее, чем в I (P< 0,05). Это свидетельствовало об эффективности применения озонотерапии при лечении обострения ХОБЛ. Таким образом, положительное влияние инфузионной озонотерапии на различные звенья воспаления при обострении ХОБЛ свидетельствуют о перспективности дальнейших исследований в этом направлении. The analysis of the results of changes in immunological parameters in the treatment of complications of COPD in 55 patients. All patients considered in our study signed a written informed consent to participate in the study program and not to disclose their personal data. Serum IgM levels in group II treated with ozone therapy 7 days after the start of treatment were significantly lower than in group I, indicating a more rapid regression of the inflammatory process in group II (P <0.05). At the same time, the incidence of HCT-induced phagocytosis in group II ozone therapy was significantly higher than in group I without ozone therapy (P <0.05). That is, in the context of ozone therapy, the reserves of oxygen-dependent phagocytic activity of neutrophils of group II were functionally active. Particular attention should be paid to the fact that the elimination of AIC in group II was faster than in group I (P <0.05). This demonstrated the effectiveness of ozone therapy in the treatment of COPD exacerbations. Thus, the positive effect of infusion ozone therapy at different stages of inflammation during the exacerbation of COPD indicates the prospects for further research in this area.

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Comparison of the Clinical Outcomes Between Nebulized and Systemic Corticosteroids in the Treatment of Acute Exacerbation of COPD in China (CONTAIN Study): A Post Hoc Analysis

International Journal of Chronic Obstructive Pulmonary Disease ◽

10.2147/copd.s255475 ◽

2020 ◽

Vol Volume 15 ◽

pp. 2343-2353

Author(s):

Yahong Chen ◽

Yang Liu ◽

Jing Zhang ◽

Wanzhen Yao ◽

Jingping Yang ◽

...

Keyword(s):

Clinical Outcomes ◽

Acute Exacerbation ◽

Acute Exacerbation Of Copd ◽

Post Hoc Analysis ◽

Systemic Corticosteroids ◽

Exacerbation Of Copd ◽

Post Hoc

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Reducing Preventable Readmissions in a Neurosurgical Patient Population at an Academic Medical Center

Neurosurgery ◽

10.1093/neuros/nyz310_434 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Shayan Moosa ◽

Lindsay Bowerman ◽

Ellen Smith ◽

Mindy Bryant ◽

Natalie Krovetz ◽

...

Keyword(s):

High Risk ◽

Patient Population ◽

Medical Center ◽

Academic Medical Center ◽

Readmission Rates ◽

Academic Medical ◽

Neurosurgical Patient ◽

Neurosurgical Patients ◽

Significant Difference

Abstract INTRODUCTION Hospital readmissions are extremely costly in terms of time and resources and negatively impact patient safety and satisfaction. In this study, we performed a Pareto analysis of 30-day readmissions in a neurosurgical patient population in order to identify patients at high-risk for readmission. Using this information, we implemented a new practice parameter with the goal of reducing preventable readmissions. METHODS Patient characteristics and causes for readmission were prospectively collected for all neurosurgical patients readmitted to an academic medical center within 30 d of discharge between July and October 2018. A program was then initiated where postoperative neurosurgical spine patients were contacted by phone at standardized intervals before their 2-wk follow-up appointment, with the purpose of more quickly addressing surgical concerns and/or coordinating care for general medical issues. Finally, 30-d readmission rates were compared between the initial 4-mo period and January 2019 through April 2019. RESULTS Prior to intervention, the largest group of readmitted patients included those who had undergone recent spinal surgery (16/47, 34%). Among spine readmissions during this time, 47% were readmitted before their two-week follow-up appointment, 67% lived over 50 miles from the medical center, and 40% were Medicare-insured. There was a statistically significant difference in the mean rate of spine readmissions per month in the periods before (7.0%) and after (3.0%) the program onset (P = .029, 57% decline). The total number of surgically and medically related spine readmissions decreased between the pre- and postintervention periods from 10 to 3 (70%) and 3 to 1 (67%), respectively. CONCLUSION Our data suggests that a large number of neurosurgical readmissions may be prevented by the simple process of early follow-up and consistent communication via telephone. Readmission rates may be further reduced by standardizing the coordination of postoperative general medical follow-up and providing thorough wound care teaching for high-risk patients.

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Medications in Bronchospasm and Asthma among the Critically Ill Patients: A Drug Utilization Study from Southern India

Nepal Journal of Epidemiology ◽

10.3126/nje.v1i2.5136 ◽

1970 ◽

Vol 1 (2) ◽

pp. 57-59

Author(s):

Lisha Jenny John ◽

Jenny John ◽

Padmini Devi ◽

Mohamed Arifulla ◽

Shoba Guido

Keyword(s):

Drug Therapy ◽

Adverse Effects ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Therapeutic Agents ◽

Prescribing Patterns ◽

Drug Utilization Study ◽

Male Preponderance ◽

Utilization Patterns

Objective: Critically ill patients are prone for altered reactivity of the airway and drug therapy has pivotal role in the management of bronchospasm. The objective of the study was to evaluate the prescribing patterns and adverse effects of therapeutic agents for bronchospasm and asthma in the medical ICU.Methods: A prospective observational study was carried out among inpatients of the medical ICU receiving drugs for bronchospasm and asthma.Results: 220 patients received drugs for bronchospasm and asthma. Male preponderance was noticed (60.5%). Salbutamol (R03AC02) 92.7% was the most common bronchodilator prescribed. Ipratropium plus salbutamol (R03AK04) 55.5% was most frequently used bronchodilator combination. All bronchodilators were administered by inhalational route (nebulization) except methylxanthines Conclusion: Utilization patterns of drugs for bronchospasm and asthma were in concordance with treatment guidelines.Key words: Bronchospasm; Asthma; Southern IndiaDOI: http://dx.doi.org/10.3126/nje.v1i2.5136 Nepal Journal of Epidemiology 2011;1 (2):57-59

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Psychoactive Drug Misuse in Long-Term Care: Some Contributing Factors

Journal of Pharmacy Practice ◽

10.1177/089719008800100307 ◽

1988 ◽

Vol 1 (3) ◽

pp. 189-194 ◽

Cited By ~ 4

Author(s):

David S. Sherman

Keyword(s):

Nursing Home ◽

Adverse Effects ◽

Nursing Home Residents ◽

Psychoactive Drug ◽

Prescribing Patterns ◽

Drug Misuse ◽

Psychoactive Drugs ◽

Contributing Factors ◽

Term Care ◽

Home Setting

Surveys have identified inappropriate psychoactive drug prescribing patterns as a major problem in the care of nursing home residents. Residents without a documented history of mental illness often receive drugs intended to treat psychiatric problems. One of the greatest areas of misuse of these drugs is in the treatment of agitation in elderly demented residents. For example, although this purpose is likely the most common reason antipsychotic drugs are used in the nursing home setting, no well designed study has yet demonstrated that these agents are effective for this problem. Elderly individuals are particularly sensitive to the adverse effects of psychoactive drugs. Due to the gradual or insidious onset of some adverse effects, psychoactive drug toxicity may often be underestimated. The most serious example of a clinically underrecognized adverse effect of psychoactive drugs is tardive dyskinesia. Misinterpretation of certain nursing home residents' behaviors may lead to medication with tranquilizing drugs when other approaches may be safer and more effective. Excessive use of psychoactive drugs is not only physically harmful, but also encourages an apathetic attitude toward implementation of more humane ways of dealing with behaviorally disturbed nursing home residents.

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Mood Disorders in Elderly Patients Hospitalized for Acute Exacerbation of COPD

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1978 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S142-S142

Author(s):

I. Bonfitto ◽

G. Moniello ◽

M. Pascucci ◽

A. Bellomo

Keyword(s):

Quality Of Life ◽

Length Of Stay ◽

Elderly Patients ◽

Acute Exacerbation ◽

Rating Scale ◽

Hospital Length Of Stay ◽

Acute Exacerbation Of Copd ◽

Copd Exacerbations ◽

Exacerbation Of Copd

IntroductionChronic obstructive pulmonary disease (COPD) represents the most common cause of chronic respiratory failure and it's associated with several comorbidities such as depression. Depression is about four times more frequent in elderly patients with COPD compared to peers who are not affected and its prevalence increases with the degree of disease severity.ObjectiveTo assess mood and perception of the quality of life in elderly patients hospitalized for acute exacerbation of COPD.MethodsThirty-five elderly patients hospitalized for reactivation of COPD were examined; they were subjected to spirometry test for the calculation of FEV1 and to COPD Assessment Test (CAT) and Hamilton Rating Scale for Depression (HAM-D) to evaluate impact of COPD on patients’ quality of life and depressive symptomatology, respectively. The number of COPD exacerbations in the last year prior to hospitalization and the number of recovery days required for the stabilization of patients were also recorded.ResultsThere were strongly significative correlations (P < 0.001), positive between HAM-D scores, CAT scores, number of exacerbation in the last year and hospital length of stay and negative between HAM-D scores and FEV1 values. Furthermore, females were more depressed, with lower FEV 1 (P = 0.043) and with a longer length of stay (P = 0.039) as compared to males.ConclusionsA greater severity of depressive symptoms is related to a greater severity of COPD exacerbations, disability associated with it and perceived by the patient, as well as a higher number of recovery days and annual acute exacerbations, particularly in female gender.

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