PT  - JOURNAL ARTICLE
AU  - Fekri Abroug
AU  - Lamia Ouanes-Besbes
AU  - Mohamed Fkih-Hassen
AU  - Islem Ouanes
AU  - Samia Ayed
AU  - Fahmi Dachraoui
AU  - Laurent Brochard
AU  - Souheil ElAtrous
TI  - Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation
AID  - 10.1183/09031936.00002913
DP  - 2013 Jan 01
TA  - European Respiratory Journal
PG  - erj00029-2013
4099  - http://erj.ersjournals.com/content/early/2013/06/21/09031936.00002913.short
4100  - http://erj.ersjournals.com/content/early/2013/06/21/09031936.00002913.full
AB  - 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.