Chronic obstructive pulmonary disease patients and steroids: benefit or harm
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20194265Keywords:
Chronic obstructive lung disease, Steroids, FVC, FEV1Abstract
Background: Corticosteroids are being widely used in conditions related to allergy and inflammation. There are great species differences in the responses to glucocorticoids that mean a “steroid resistant” species. Steroids have profound effect on inflammatory response by way of vasoconstriction, decreased chemotaxis and interference with macrophages. There still are enormous gaps in our knowledge of the action of glucocorticosteroids in patients of chronic obstructive lung disease (COPD).
Methods: This study was done in the department of general medicine at SKIMS, Srinagar from December 2017 to December 2018 on patients of chronic obstructive pulmonary disease. A total number of 100 patients were enrolled for the study but 20 patients, 10 from each group lost their follow up. To see the effect of steroids on pulmonary function tests, patients were divided into case and control group. Patients in case group were given prednisolone 30 mg orally for two week (tapering dose). Patients in control group were given placebo for the same duration of two weeks. Steroid response was defined as 15% improvement in baseline forced expiratory volume (FEV).
Results: Steroid response was defined as 15% increase in forced expiratory volume in one second/forced vital capacity (FEV1/FVC) after receiving tapering dose of prednisone 30 mg for 2 weeks, no patients in case group showed increase in FEV1/FVC of 15%. The change in pulmonary function tests was comparable in each group (p>0.5).
Conclusions: The change in pulmonary function tests were comparable in each group (p>0.5). So, steroids in stable patients of COPD are best to be avoided.
References
Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J. 2006;28(3):523–32.
American Thoracic Society: Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease and asthma. Am Rev Respir Dis. 1987;36:225-8.
Harrison's Principles of Internal Medicine. 18th edition. McGraw Hill Education; 2011: 1491-1499.
CIBA Guest symposium: Terminology, dysfunction and classification of chronic pulmonary emphysema and related conditions thorax. Thorax. 1959;4:286.
Fletcher C, Peto R. The natural history of chronic airflow obstruction. Br Med J. 1977;1:1645-8.
Sridhar M, Taylor R, Dawson S, Roberts NJ, Partridge MR. A nurse led intermediate care package in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2008;63(3):194–200.
Lynne Reid .Measurement of the bronchial mucous gland layer a diagnostic yard stick in chronic bronchitis. Thorax. 1960;15:132-41.
Hossain S, Heard B. Hyperplasia of bronchial muscle in chronic bronchitis. 1970;101:171-84.
Effing T, Kerstjens H, van der Valk P, Zielhuis G, van der Palen J. Cost-effectiveness of self-treatment of exacerbations on the severity of exacerbations in patients with COPD: the COPE II study. Thorax. 2009;64(11):956–962.
Segal MS, Dulfano MJ. Chronic Pulmonary Emphysema: Physiopathology and treatment. New York: Grune; 1953: 107-112.
Lowell FC, Franklin W Michelson A, Schiller W. Chronic obstructive pulmonary emphysema: disease of smokers. Ann Int Med. 1956;45:268-74.
Costo M, Ghezzo H, Hogg JC, Corbin R, Loveland M, Dosman J, et al. The relations between structural changes in small airways and pulmonary function test. New England J Med. 1978;298:1277-81.
American Thoracic Society. Lung function testing selection of reference values and interpretative strategies. American review of respiratory diseases. 1991;144:1202-18.
Gevardo S, Pedro S, Ronald B, George MD. Current pulmonology and critical care medicine. Internal Med. 1980;17:181-200.
Millard J, Filler JC. The treatment of chronic bronchitis. Geriatrics. 1965;20: 854.
Andrews AH, Coogan TJ. Office management of chronic obstructive emphysema and related conditions. Med Clin N Amer. 1958;92:155.
Beerel F, Jick H, Tyler JM. A controlled study of the effect of prednisone on air flow obstruction in severe pulmonary emphysema. New Eng J Med. 1963;226:68.
Fan VS, Gaziano JM, Lew R, Bourbeau J, Adams SG, Leatherman S, et al. A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: a randomized, controlled trial. Ann Intern Med. 2012;156(10):673–83.
Chang S, Henry W. Response to corticosteroid in chronic bronchitis. J Allergy Clin Immunol. 1978;62:363-7.
Sahn SA. Corticosteroids in Chronic bronchitis and Pulmonary emphysema. Chest. 1987;73:389-96.
Dujoune CA, Azarnoff DL. Clinical complications of corticosteroid therapy: A selected review. Med Clin North Am. 1973;57:1331-42.
Cullen JH, Reidt WH. American review of respiratory diseases.1960;82:508.
