Nebulized corticosteroids in the management of acute exacerbation of COPD

G S Gaude, S Nadagouda, G S Gaude, S Nadagouda

Abstract

Acute exacerbations in chronic onstructive pulmonary disease (COPD) are common and systemic steroids play an important role in the management of these cases along with the bronchodilators. Nebulized budesonide is being used in the acute attacks of bronchial asthma either in children or in adults. But the role of nebulized steroids in acute exacerbation of COPD is not much studied in the literature. In this clinical review we have evaluated the role of nebulized corticosteroids in the management of acute exacerbation of COPD (AECOPD). Through Medline, Pubmed and Embase we analyzed the various studies that has been done to study the role of nebulized corticosteroids in the management of acute exacerbation of COPD. The key words used for the search criteria were: acute exacerbation, COPD, nebulized corticosteroids, budesonide, fluticasone. Only eight studies were found which had evaluated the role of nebulized corticosteroids in acute exacerbations of COPD. All these studies had used nebulized budesonide in AECOPD in different dosages, and had been compared with both either parental or oral steroids, and standard bronchodilator therapy. All the studies had found the clinical efficacy of nebulized budesonide to be of similar extent to that of either parental or oral steroids in AECOPD. Side effects profile of nebulized budesonide was minimal and acceptable as compared to systemic steroids. Nebulized budesonide may be an alternative to parental/oral prednisolone in the treatment of acute exacerbations of COPD but further studies should be done to evaluate its long-term impact on clinical outcomes after an initial episode of COPD exacerbation.

Keywords: Budesonide; COPD; corticosteroids; exacerbation; nebulized steroids.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: A summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932–46.
    1. ™Global strategy for agnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2009. Bethesda, MD: National Heart, Lung, and Blood Institute, National Institutes of Health; 2009. Global Initiative for Chronic Obstructive Lung Disease (GOLD)
    1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997;349:1498–504.
    1. Hattsville: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009. Third National Health and Nutrition Examination Survey (NHANES III) Public-Use Data Files.
    1. Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbation of COPD. Ann Intern Med. 1987;166:196–204.
    1. Adams SG, Melo J, Luther M, Anzueto A. Antibiotics are associated with lower relapse rates in outpatients with acute exacerbations of COPD. Chest. 2000;117:1345–52.
    1. Vestbo J, Prescott E, Lange P. Association of chronic mucus hypersecretion with FEV1 decline and COPD morbidity. Copenhagen City Heart Study Group. Am J Respir Crit Care Med. 1996;153:1530–5.
    1. Kanner RE, Anthonisen NR, Connett JE. Lung Health Study Research Group. Lower respiratory illnesses promote FEV1 decline in current smokers but not ex-smokers with mild chronic obstructive pulmonary disease: Results from the lung health study. Am J Respir Crit Care Med. 2001;164:358–64.
    1. Burge PS, Calverley PM, Jones PW, Spencer S, Anderson JA, Maslen TK. Randomized, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: The ISOLDE trial. BMJ. 2000;320:1297–303.
    1. Vestbo J, Sorensen T, Lange P, Brix A, Torre P, Viskum K. Long-term effect of inhaled budesonide in mild to moderate chronic obstructive pulmonary disease: A randomised controlled trial. Lancet. 1999;353:1819–23.
    1. Pauwells RA, Lofdahl CG, Pride NB, Postma DS, Laitinen LA, Ohlsson SV. European Respiratory Society study on chronic obstructive pulmonary disease (EUROSCOP): Hypothesis and design. Eur Respir J. 1992;5:1254–61.
    1. Seemungal TA, Donaldson GC, Bhowmik A, Jeffries DJ, Wedzicha JA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2000;161:1608–13.
    1. Singh JM, Pada VA, Stanbrook MB, Chapman KR. Corticosteroid therapy for patients with acute exacerbation of chronic obstructive pulmonary disease. Arch Intern Med. 2002;162:2527–36.
    1. Barnes PJ. Anti-inflammatory actions of glucocorticoids: Molecular mechanisms. Clin Sci. 1998;94:557–72.
    1. Gunen H, Mirici A, Meral M, Akgun M. Steroids in acute exacerbations of chronic obstructive pulmonary disease: Are nebulized and systemic forms comparable? Curr Opin Pulm Med. 2009;15:133–7.
    1. Welte T. Inhaled corticosteroids in COPD and the risk of pneumonia. Lancet. 2009;374:668–70.
    1. Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med. 2000;343:1902–29.
    1. Novak B. The role of corticosteroids in acute exacerbations of chronic obstructive pulmonary disease. Crit Care Nurse. 2002;22:80–1.
    1. Yang IA, Fong K, Sim EH, Black PN, Lasserson TJ. Inhaled corticosteroids for stable chronic obstructive pulmonary disease. Cochrane Database System Rev. 2007;2:CD002991.
    1. Gartlehner G, Hansen RA, Carson SS, Lohr KN. Efficacy and safety of inhaled corticosteroids in patients with COPD: A systematic review and meta-analysis of health outcomes. Ann Fam Med. 2006;4:253–62.
    1. Mitchell CE, Alpers JH, Morton SM, Baggoley CJ, Croker WD, Walsh AJ, et al. Comparison of nebulized budesonide with oral prednisolone in the treatment of severe acute asthma. Eur Respir J. 1995;8:S490.
    1. Matthews EE, Curtis PD, McLain BI, Morris LS, Turbitt ML. Nebulized budesonide versus oral steroid in severe exacerbations of childhood asthma. Acta Paediatr. 1999;88:841–3.
    1. Devidayal, Singhi S, Kumar L, Jayshree M. Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma. Acta Paediatr. 1999;88:835–40.
    1. Morice AH, Morris D, Lawson-Matthew P. A comparison of nebulized budesonide with oral prednisolone in the treatment of exacerbations of obstructive pulmonary disease. Clin Pharmacol Ther. 1996;60:675–8.
    1. Maltais F, Ostinelli J, Bourbeau J, Tonnel A, Jacquemet N, Haddon J, et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;165:698–703.
    1. Mirici A, Meral M, Akgun M. Comparison of the efficacy of nebulised budesonide with parenteral corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Clin Drug Invest. 2003;23:55–62.
    1. Gunen H, Hacievliyagil SS, Yetkin O, Gulbas G. The role of nebulised budesonide in the treatment of acute exacerbations of COPD. Eur Respir J. 2007;30:399–400.
    1. Wei H, Xin Z. Practical Clin Med Mag. 2004. Nebulised budesonide in the treatment of acute exacerbations of chronic obstructive pulmonary disease; p. 3. [last cited on 2004]; Available from: http://wwwscholarilibcn/A-jslcyxzz200402003html [last accessed on 2009 Oct 25]
    1. Guozhong C, Wen X, Qi Z, Liang Z, Guozhong C, Huiwen XU, et al. Chinese General Medicine. 2005. The effect of inhaled budesonide in persons with acute exacerbations of chronic obstructive pulmonary disease; p. 3. [last cited on 2005]; Available from: [last accessed on 2009 Oct 25]
    1. Marcus P. Budesonide inhalation suspension in adults with poorly controlled asthma or chronic obstructive pulmonary disease. J Appl Res. 2009;9:3–13.
    1. Gaude GS, Nemagouda S. Clinical efficacy of nebulized budesonide with parental/oral steroids in patients with acute exacerbation of COPD: A prospective study in tertiary care hospital. Lung India. 2009;26:S11–2.

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