0
Editorial |

Toward Personalized Prescription of Systemic Steroids for Patients Hospitalized With COPD Exacerbations

Pierre-Régis Burgel, MD, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST the following: P.-R. B. reports personal fees from Astra-Zeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, Pfizer, and Vertex for attending advisory boards and lecturing during the last 3 years. He was also the principal investigator of a clinical trial sponsored by Novartis and received an unrestricted research grant from Boehringer Ingelheim France.

Department of Respiratory Diseases, Cochin Hospital, Paris, France

CORRESPONDENCE TO: Pierre-Régis Burgel, MD, PhD, Department of Respiratory Diseases, Cochin Hospital, 27 rue du Faubourg St Jacques, 75014, Paris, France


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):268-269. doi:10.1016/j.chest.2016.03.028
Text Size: A A A
Published online

Extract

Hospitalized exacerbations are important events in patients with COPD because they are responsible for high costs and have great impact on patient’s symptoms and prognosis. Review of high-quality randomized clinical trials in patients hospitalized for COPD exacerbations has established that systemic steroids significantly reduced treatment failure, were associated with earlier improvement in lung function and dyspnea, and shortened hospital stay. However, beneficial effects of systemic steroids came with high rates of adverse effects (including hyperglycemia), with one extra adverse effect occurring for every six people treated. These conclusions were based on studies that have used various protocols for steroid administration, including studies that used very high doses of steroids and administration of steroids for up to 8 weeks. Subsequent studies have suggested that low-dose steroids (30-40 mg/d) administered orally were not associated with worse outcomes than high-dose intravenous therapy and that a shorter duration (5 days) of oral prednisone was noninferior to 14-day treatment. This led to current recommendations of using low-dose short-term oral steroids in patients hospitalized for COPD exacerbations with the aim of limiting adverse events, which still occurred in approximately one to ten patients. Because results of clinical trials provide only limited information on the individual likelihood of benefiting from or being harmed by a therapy, a more personalized approach of steroid prescription in COPD exacerbation is urgently required, with the aim of limiting steroid prescription to patients who may show high benefits and low rates of adverse effects.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543