Enfermedad pulmonar obstructiva crónica

High doses of systemic corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease. A cohort study

OBJECTIVES

To assess the effect of high doses of corticosteroids in patients hospitalised for exacerbation of chronic obstructive pulmonary disease (COPD).

PATIENTS AND METHODS

A prospective cohort study was conducted on patients hospitalized with COPD between January and March 2015, grouped according to the glucocorticoid dosage administered (cutoff, 40mg of prednisone/day). We compared the results of hospital stay, readmission and mortality at 3 months of discharge.

RESULTS

We analysed 87 patients. The median daily dose was 60mg of prednisone (interquartile range, 46.67-82.33mg/day), and the administration route was intravenous in 96.6% of the cases. We established a relative risk (RR) for hospital stays longer than 8 days of 1.095 (95% CI 0.597-2.007; P=.765) when steroid dosages greater than 40mg/day were employed. In these patients, the hazard ratio (HR) for readmission in the 3 months after discharge was 0.903 (95% CI 0.392-2.082; P=.811), and the mortality was 1.832 (95% CI 0.229-16.645; P=.568). Neither the RR nor the HR varied in a statistically significant manner after adjusting for confounding factors.

CONCLUSIONS

A daily dose greater than 40mg of prednisone in patients hospitalised for COPD exacerbation was not associated with a shorter hospital stay or a reduction in readmissions or mortality at 3 months.

[Individually-tailored treatment of chronic obstructive pulmonary disease: a proposed change]

Chronic obstructive pulmonary disease (COPD) is a highly prevalent but poorly defined disease and there is wide confusion regarding its treatment. The available knowledge should allow guidelines for specific treatment to be established according to each patient's clinical features. The present article describes a proposal for individually-tailored treatment. Long-acting bronchodilators, alone or in various combinations, would be the basis of treatment and inhaled corticosteroids (IC) should be used in a subgroup with well-defined characteristics. The latest studies indicate that the benefits of IC are limited in COPD and that the risks are not inconsiderable. Consequently, these drugs should be limited to "responders" and should always be administered in association with a long-acting beta(2) bronchodilator. The pathogenesis of this disease should be studied in greater depth and patients should be classified according to their severity, the frequency of acute exacerbations, their reversibility, comorbidity and concomitant medication in order to choose the most appropriate treatment.

Augmentation therapy for emphysema due to alpha-1-antitrypsin deficiency

Alpha-1 antitrypsin deficiency (AAT) is a hereditary recessive autosomal disease caused by mutations in the AAT gene. This disease is characterized by abnormally low AAT concentrations in plasma, which, in its homozygote form, carries a high risk for the development of early pulmonary emphysema and liver damage. Since the end of the 1980s augmentation therapy with AAT from human plasma has been available for specific treatment of emphysema due to AAT deficiency. Intravenous augmentation therapy has been demonstrated to be safe and weekly infusions of AAT have resulted in plasma AAT concentrations above those considered protective for the lungs. However, life-long weekly infusions are not well accepted by patients, therefore pharmacokinetic studies have been performed to try to individualize the therapeutic regimen in order to obtain adequate trough serum AAT levels with prolonged intervals of administration. Therapeutic regimens administered every two weeks appear to be safe and result in adequate trough serum concentrations, but less-frequent administrations result in trough levels below the target. Alpha-1-antitrypsin deficiency is largely unrecognized and underdiagnosed. The foundation of national and international registries is a valid strategy to increase awareness about the disease and collect information about the natural history of this deficiency. Furthermore, the identification of a large number of patients will allow the development of new clinical trials aimed at finding better treatments for this infrequent condition.

La calidad de vida en los pacientes con enfermedad pulmonar obstructiva crónica: criterios de cuantificación y repercusiones terapéuticas

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent chronica diseases in developed countries. Prognosis of the disease is mainly determined by the degree of air flow obstruction. However, other factors, such as degree of deterioration of the quality of life related with health have been demonstrated to be significantly correlated with morbidity and mortality in COPD. Thus, one of the main objectives of the treatment of COPD is to improve the health condition of the patients, beyond the possible improvement of the lung function. New drugs developed for the treatment of COPD have shown a different impact on the health condition of those affected by COPD.