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Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation

Fekri Abroug, Lamia Ouanes-Besbes, Mohamed Fkih-Hassen, Islem Ouanes, Samia Ayed, Fahmi Dachraoui, Laurent Brochard, Souheil ElAtrous
European Respiratory Journal 2013; DOI: 10.1183/09031936.00002913
Fekri Abroug
*Intensive Care Unit. CHU Fattouma Bourguiba. Monastir. University of Monastir. Tunisia
¶Laboratoire de Recherche LR12SP15 “Recherche cardiopulmonaire en médecine intensive et Toxicologie”
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  • For correspondence: f.abroug@rns.tn
Lamia Ouanes-Besbes
*Intensive Care Unit. CHU Fattouma Bourguiba. Monastir. University of Monastir. Tunisia
¶Laboratoire de Recherche LR12SP15 “Recherche cardiopulmonaire en médecine intensive et Toxicologie”
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Mohamed Fkih-Hassen
#Intensive Care Unit. CHU Tahar Sfar. Mahdia. University of Monastir. Tunisia
¶Laboratoire de Recherche LR12SP15 “Recherche cardiopulmonaire en médecine intensive et Toxicologie”
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Islem Ouanes
*Intensive Care Unit. CHU Fattouma Bourguiba. Monastir. University of Monastir. Tunisia
¶Laboratoire de Recherche LR12SP15 “Recherche cardiopulmonaire en médecine intensive et Toxicologie”
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Samia Ayed
#Intensive Care Unit. CHU Tahar Sfar. Mahdia. University of Monastir. Tunisia
¶Laboratoire de Recherche LR12SP15 “Recherche cardiopulmonaire en médecine intensive et Toxicologie”
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Fahmi Dachraoui
*Intensive Care Unit. CHU Fattouma Bourguiba. Monastir. University of Monastir. Tunisia
¶Laboratoire de Recherche LR12SP15 “Recherche cardiopulmonaire en médecine intensive et Toxicologie”
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Laurent Brochard
+ICU Division, Dept of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospital. University of Geneva Switzerland
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Souheil ElAtrous
#Intensive Care Unit. CHU Tahar Sfar. Mahdia. University of Monastir. Tunisia
¶Laboratoire de Recherche LR12SP15 “Recherche cardiopulmonaire en médecine intensive et Toxicologie”
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Abstract

Recommendations of systemic steroids in COPD exacerbation rely on trials that excluded patients requiring ventilatory support.

in an open-label, randomised evaluation of oral prednisone administration, 217 patients with acute COPD exacerbation requiring ventilatory support were randomised (with stratification on the type of ventilation) to usual care (n=106), or to receive a daily dose of prednisone (1 mg·kg−1) for up to 10 days (n=111).

There was no difference regarding the primary end-point, in-ICU mortality: 17 deaths (15.3%) vs 15 deaths (14%), in steroid treated and in control groups, respectively (Relative risk: 1.08, 95%CI: 0.6–2.05). Analysis according to ventilation modalities showed similar mortality rates. NIV failed in 15.7% and 12.7% (RR: 1.25, 95%CI: 0.56–2.8, p=0.59), respectively. Both study groups had similar median mechanical ventilation duration, and ICU length of stay: 6 (3–12) days vs 6 (3.8–12), and 9 (6–14) vs 8 (6–14), respectively. Hyperglycaemic episodes requiring initiation or alteration of current insulin doses occurred in 55 patients (49.5%) vs 35 patients (33%) in prednisone and control groups, respectively (RR: 1.5, 95%CI: 1.08–2.08; p=0.015).

Prednisone did not improve ICU mortality or patient-centred outcomes in the selected subgroup of COPD patients with severe exacerbation. It significantly increased the risk of hyperglycaemia.

  • Acute respiratory failure
  • COPD
  • COPD exacerbation
  • mechanical ventilation
  • steroids
  • ERS
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Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation
Fekri Abroug, Lamia Ouanes-Besbes, Mohamed Fkih-Hassen, Islem Ouanes, Samia Ayed, Fahmi Dachraoui, Laurent Brochard, Souheil ElAtrous
European Respiratory Journal Jan 2013, erj00029-2013; DOI: 10.1183/09031936.00002913

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Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation
Fekri Abroug, Lamia Ouanes-Besbes, Mohamed Fkih-Hassen, Islem Ouanes, Samia Ayed, Fahmi Dachraoui, Laurent Brochard, Souheil ElAtrous
European Respiratory Journal Jan 2013, erj00029-2013; DOI: 10.1183/09031936.00002913
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