Clinical Study Of Inhaled Corticosteroids In The Treatment Of AECOPD

Chronic obstructive pulmonary disease（COPD）is a group of lung diseases characterized by airflow limitation.The morbidity and mortality are high.The main pathological basis of chronic obstructive pulmonary disease is the chronic nonspecific Inflammation of airway,lung parenchyma and pulmonary vessels.In recent years,COPD has become one of the most rapidly growing cause of death in developed countries.While the mortality of cardiovascular and cerebrovascular diseases was obviously decreased,the mortality rate of COPD was increased by 163%,and the prevalence rate of was increasing[1].A recent epidemiological study in China also shows that[2],the incidence of COPD was 8.2% in the population over 40 years old in our country,and there was a trend of increasing year by year.At present,it is generally accepted that infection is the most important cause of acute exacerbation of COPD patients.And repeated acute exacerbation of COPD patients will accelerate the deterioration of the patient’s condition,and ultimately lead to death.The clinical efficacy of corticosteroids in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease（AECOPD）is effective.However,due to the adverse effects caused by the use of systemic corticosteroids（such as osteoporosis,high blood glucose）,the clinical application of glucocorticoids is restricted[3].Some foreign scholars pointed out that the systemic effects of glucocorticoids therapy on blood glucose in patients with AECOPD was significantly higher than that of inhaled corticosteroids in[4],and even a single systemic glucocorticoids therapy can also increase the risk of fracture in elderly patients[5].At present,there is still a lot of controversy over the use of the glucocorticoids and the way in which the drug is administered and how much it is administered.Objective: To evaluate the efficacy and safety of inhaled corticosteroids in the treatment of acute exacerbation of chronic obstructive pulmonary disease.Methods: We selected 120 patients who were diagnosed as acute exacerbation of chronic obstructive pulmonary disease and were hospitalized in the Respiratory department of internal medicine of General Hospital of Beijing Military Region from June 2014 to December 2015.These patients were randomly divided into three groups.The control group included 40 patients,they were given routine treatment of anti infection,bronchodilator,expectorant and antiasthmatic etc.Inhaled budesonide group（referred to as: the inhalation group）included 39 patients,they were treated on the basis of conventional therapy,combined with budesonide inhalation（dose: 2mg / time,3 / day）.Intravenous methylprednisolone group（referred to as: the intravenous group）included 38 patients,they were treated on the basis of conventional treatment and injection with methylprednisolone intravenous drip（dose: 40 mg / time,once a day）.We compared the treatment of clinical symptoms remission,lung function（FEV1%,FEV1 / FVC）,arterial blood gas（PaO2,PaCO2）,fasting blood glucose,serum K +,Ca²⁺ concentration in the blood and the emergence of drug adverse reactions,to evaluate the use of inhaled the clinical curative effect of glucocorticoids in the treatment of AECOPD.Results: A Patient of the inhalation group withdrew from this study,because he felt dejected,dyspnea and difficult to tolerate in the treatment.2 patients of the intravenous group were excluded because of their poor compliance.Finally,117 of 120 patients completed the clinical study.We analyzed the age,sex,lung function,fasting blood glucose,blood K+ and Ca²⁺ levels of patients at admission of three groups.The differences were not statistically significant in the three groups（P<0.05）.1.Clinical efficacy: After treatment,the effective rates of the inhalation group and intravenous group were significantly higher than the control group（both P<0.05）.But there was no significant difference in clinical efficacy between the two groups（P>0.05）.2.Pulmonary function tests: The pulmonary function of the three groups was improved after treatment（all P<0.05）.Compared with the control group,there was a greater magnitude of improvement in the inhalation group and the intravenous group after the treatment（both P<0.05）.Differences between two groups were no statistically significant（P>0.05）.3.Arterial blood gas analysis: After treatment,Pa O2 and Pa CO2 of all groups were significantly improved（all P<0.05）.Compared with the control group,the improvement of the inhalation group and the intravenous group was more obvious（both P<0.05）.But differences between two groups were no statistically significant（P>0.05）.4.Fasting blood glucose: After the treatment,the levels of fasting blood glucose in the three groups had significantly increased（all P<0.05）.The level of the intravenous group increased higher than the other two groups（both P<0.05）.But the differences between the inhalation group and the control group were no statistically significant（P>0.05）.5.The concentration of Serum K+ and Serum Ca²⁺: After treatment,the levels of serum K+ and Ca²⁺ were significantly decreased in the three groups（all P<0.05）.Although the effect of serum K+ and Ca²⁺ concentrations in patients with venous group therapy was most significant,the inhalation group was ranked in second place.Through statistical analysis,it was found that there was no significant difference between the three groups in the effect of the concentration of K+ and Ca²⁺ in the serum of the patients（P>0.05）.6.Adverse reactions: Adverse reactions occurred in three groups.The incidence of adverse reaction was highest in the intravenous group,second in the atomization group.The incidence of adverse reaction of the intravenous group increased higher than the other two groups（both P<0.05）.But the differences between the inhalation group and the control group were no statistically significant（P>0.05）.Conclusion: Giving glucocorticoids therapy in patients with AECOPD,can effectively relieve the clinical symptoms,improve the pulmonary function and the state of arterial blood gas.For patients with moderate to severe AECOPD,compared with systemic corticosteroids,inhaled corticosteroids can be obtained with the same effect and have less effect on the fasting blood glucose,relatively few cause adverse reaction.At the same time,our study found that glucocorticoids had no effect on the serum potassium and calcium concentration.Therefore,for patients with moderate to severe AECOPD,we recommend the use of inhaled corticosteroids in the local administration.