Clinical Observation Of Different Courses Of Glucocorticoid In The Treatment Of AECOPD

Background The inflammatory cells in the airway of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)are significantly higher than those of patients at stable stage,it is very important to give anti-inflammatory treatment to patients with acute exacerbation of COPD.However,the optimal dose and duration of glucocorticoid therapy for COPD exacerbations are unknown.Objective To compare the clinical efficacy of different courses of systemic glucocorticoid in patients with AECOPD and to determine the optimal drug withdrawal protocol for Glucocorticoid,it provides a reference for the best course and dosage of Glucocorticoid in the treatment of acute exacerbation of COPD.Methods Patients diagnosed with AECOPD in outpatient and inpatient cases in the Department of Respiratory and Critical Care Medicine at the People’s Hospital of Three Gorges University were collected from May 2019 to December 2019,and 100 eligible patients with AECOPD were screened according to the inclusion and exclusion criteria and randomly divided into a 5-day therapy group and a 10-day therapy group,and and data on gender,age,body mass index(BMI),number of smokers,smoking index,history of COPD,number of acute exacerbations in the previous 1 year,and lung function classification were collected from both groups.Pre-treatment pulmonary function(including: 1 second Forced Expiratory Volume(FEV1),FEV1%,Forced vital capacity(FVC),FEV1/FVC%,peak expiratory flow(PEF))and blood inflammatory parameters(including leukocytes,neutrophils,eosinophils,serum C-reaction protein(CRP))were measured in both groups.The degree of dyspnea and clinical symptoms were assessed using the modified British Medical Research Council(m MRC)questionnaire and the COPD Assessment Test(CAT)questionnaire,and the results were recorded.In terms of treatment,patients in both groups were given conventional treatment such as anti-infection and nebulization to calm asthma according to the guideline,and on the basis of conventional treatment,patients in both groups were given a 5-day course and a 10-day course of systemic glucocorticoid(GC)respectively.The above tests/questionnaires were repeated after completion of treatment.All patients were followed up for 1 year,and the changes in pulmonary function,CAT questionnaire and m MRC questionnaire scores were observed at the 1st,3rd,6th and 12 th months of follow-up,and the number of recurrent acute exacerbations was recorded.Conclusions were drawn by comparing each observation index before and after treatment within and between groups.The effect of risk factors such as age,BMI,number of previous 1-year acute exacerbations,and lung function classification on patients’ recurrent acute exacerbations within 1 year were also assessed using logistic regression analysis.Results(1)There were no significant differences in sex ratio,age,BMI,number of smokers,smoking index,history of COPD,number of acute exacerbations in the past year and Pulmonary Function Classification(P>0.05).There is clinical comparability.(2)The pulmonary function parameters(FEV1,FVC,FEV1%,FEV1/FVC,PEF)of the two groups were significantly lower than those pre-treatment of GC(P<0.01),there was no significant difference in pulmonary function parameters between the two groups after treatment(P>0.05).After one year follow-up,FEV1 in both groups decreased(P<0.01),and there was no significant difference in FEV1 between the two groups(P>0.05).The patients in the two groups were divided into two subgroups: no previous acute exacerbation and the number of previous acute exacerbations ≥1.There was a significant difference in FEV1 between the subgroups of the 5-day therapy Group(P<0.01),and between the subgroups of the 10-day therapy group(P<0.01).There was no significant difference between the 5-day therapy Group and the 10-day therapy Group(P>0.05).(3)The scores of m MRC and CAT were significantly lower in the two groups after GC treatment than before(P<0.01),but there was no significant difference between the two groups in the score of m MRC and CAT questionnaire after treatment(P>0.01).After 1-year follow-up,there was no significant difference in the scores of m MRC and CAT between the two groups(P>0.05).(4)In the 5-day treatment group,the white blood cell and neutrophil count were significantly lower than those pre-treatment of GC(P>0.05);In the 10-day treatment group,the white blood cell and neutrophil count increased after GC treatment(P<0.01).After treatment,the Eosinophil granulocyte count and CRP in both groups were significantly lower than those pre-treatment of GC(P<0.05).There was no significant difference in the indexes of blood inflammation between the two groups(P>0.05).(5)During the treatment period,three adverse reactions were observed: hyperglycemia,gastric discomfort and hypokalemia.The incidence of adverse reactions in the 5-day treatment group was lower than that in the 10-day treatment group(P<0.05).(6)There was no significant difference in recurrence between the two groups(P>0.05).According to the classification of pulmonary function,the two groups were divided into three subgroups.There was no significant difference between each subgroup in the two groups.The higher the pulmonary function grade was,the higher the recurrence rate of acute exacerbation was(P<0.05).(7)Logistic regression analysis was used to evaluate the influence of age,the number of acute exacerbations in the previous year and the classification of pulmonary function on the recurrence of acute exacerbations.The risk of recurrent acute exacerbations increased by3.704-fold for each additional exacerbation in the previous 1 year [95%CI(1.66,8.268),P=0.001].The risk of recurrence of acute exacerbations increased 2.344 fold with each increase in pulmonary function score [95%CI(1.229,4.468),P=0.01].Conclusion(1)In the treatment of AECOPD,the short-term effect of hormone therapy is similar whether using 5-day therapy or 10-day therapy.Longer courses of hormone therapy do not further enhance clinical outcomes and reduce the risk of recurrence.The incidence of adverse reactions of 5-day treatment was lower.Therefore,5-day therapy is recommended.(2)It is not reliable to use leukocyte count to reflect the status of infection in AECOPD patients.Compared to white blood cells,CRP can differentiate between elevated WBC count caused by glucocorticoid.(3)The number of acute exacerbations in the past year and the pulmonary function grading can be used as predictors of the recurrence of acute exacerbations in COPD patients.