Outcomes of COPD Exacerbations Treated with Corticosteroids, Antibiotics, or Both

الملخص EN

Background.

The outcomes for outpatient treatment of acute exacerbations of COPD (AECOPD) are poorly described.

Design.

The results of a daily diary recording symptoms and peak flows were compiled into a severity score to trigger algorithm-based treatments and a symptom index to follow treatment response.

Treatment failure (symptom index failing to return to baseline for 2 consecutive days or hospitalization within 21 days) was the main outcome.

Results.

Twenty-two patients (FEV1 0.81 ± 0.26 L) were treated for 115 AECOPDs (corticosteroids = 36, antibiotics = 41, corticosteroids/antibiotics = 38).

Treatment failure was 50% for the corticosteroid/antibiotic compared to 28% (P=0.006) for the corticosteroid and 34% (P<0.0001) for the antibiotic group.

Patients suffering from AECOPDs treated with corticosteroids had dyspnea, wheezing, and decreased peak flow; those treated with antibiotics had sputum symptoms; those treated with corticosteroids/antibiotics had dyspnea, wheezing, sputum symptoms, and decreased peak flows.

Conclusions.

AECOPDs with both dyspnea and sputum symptoms are more refractory to standard treatment and likely require closer monitoring.