PURPOSE: While systemic corticosteroids (CS) are known to improve outcomes in AECOPD, it is not known whether the benefits of CS extend to AECOPD complicated by pneumonia. Moreover, it is not known whether the presence of concomitant pneumonia tempers the clinical use of CS by physicians in AECOPD.
METHODS: A retrospective review was performed to identify patients admitted to a tertiary-care institution between July 2007 and June 2009 with an AECOPD (Anthonisen’s Criteria) and radiographic findings compatible with pneumonia. Patients also had to have prior or current spirometry confirming the diagnosis of COPD, with a post-bronchodilator FEV1/FVC ratio <0.7, in order to be eligible for analysis.
RESULTS: 286 charts were fully reviewed to identify 40 patient admissions that satisfied all inclusion criteria - 78% of whom received CS (CS n=31 patients vs NoCS n=9 patients). The most common reason why patients were excluded from analysis was a lack of prior or current spirometry. Mean age of patients was 73.8±12.1 yrs vs 81.7±5.1 yrs (p=0.008; CS vs NoCS). Mean FEV1 was 1.14±0.43 L vs 1.24±0.24 L (p=NS); 48.6±17.0 %predicted vs 55.9±13.3 %predicted (p=NS), while the mean FEV1/FVC ratio was 46±13% vs 50±10% (p=NS). There were 2 vs 0 intubations (p=NS), 2 vs 0 ICU admissions (p=NS), and 3 vs 0 deaths (p=NS) in the CS group vs NoCS groups.
CONCLUSION: There is inconsistent use of CS in patients admitted to hospital for AECOPD complicated by pneumonia, although most patients admitted to hospital in this setting did receive concomitant CS therapy. Patients receiving CS were younger, although lung function was not significantly difference between the CS and NoCS groups.
CLINICAL IMPLICATIONS: The practical clinical issue of CS use in patients with AECOPD and pneumonia requires further study. Concerns about possible adverse effects on immunity vs the documented benefits of CS use in AECOPD are difficult to evaluate - a prospective randomized trial is necessary.The authors would like to thank the Lung Association of Saskatchewan and the Saskatoon Health Region for their support.
DISCLOSURE: Julian Tam, University grant monies University of Alberta, University of Ottawa; Grant monies (from sources other than industry) Canadian Institute of Health Research, Lung Association of Saskatchewan, Saskatchewan Health Research Foundation; Grant monies (from industry related sources) Astra Zeneca, Boehringer-Ingelheim, GlaxoSmithKline, Novartis, Pfizer, Schering-Plough; Employee University of Saskatchewan; Fiduciary position (of any organization, association, society, etc, other than ACCP Canadian COPD Alliance, Saskatchewan Lung Association; Consultant fee, speaker bureau, advisory committee, etc. Astra Zeneca, Boehringer Ingelheim, Canadian Lung Association, GlaxoSmithKline, Health Canada, Health Quality Council, Nycomed, Pfizer, Saskatchewan Ministry of Health, Saskatoon Health Region; No Product/Research Disclosure Information