| In recent years, there has been an increase in prevalence rate and fatalityrate associated with chronic obstructive pulmonary disease (COPD) year byyear, which seriously threatens people’s health and brings a heavy financialburden to the community. Each acute exacerbation will cause the lung functiondropping sharply, so it is necessary to make active treatment on AECOPD toslow the clinical course and reduce the case fatality. Systemic glucocorticoidcan accelerate recovery, improve lung function, reduce treatment failure rateand shorten inpatient time, which has become a consensus, but its side effectsshould not be ignored, especially for elderly patients who are often associatedwith hypertension, coronary heart disease and others, so it’s important to find abetter treatment strategy.Objective:In patients with acute exacerbation of chronic obstructive pulmonarydisease, compare the clinical efficacy of atomization inhaled glucocorticoid andsystemic glucocorticoid.Methods:We choose110patients who were diagnosed as acute exacerbation of chronic obstructive pulmonary disease and in line with inclusion criteria in therespiratory department of The First Hospital of Jilin University from Jan.2014to Nov.2014. The patients were assigned randomly into3groups, namely theinhalation group (n=37), the intravenous group (n=38), control group (n=35).All the patients received conventional therapy such as oxygen inhalation,anti-inflammation, bronchodilators and mucolytics and so on. At the same time,2mg of budesonide nebulization every8hours (the inhalation group, n=37),40mg methylprednisolone intravenous injection once daily (the intravenousgroup, n=38), nil glucocorticoid (control group, n=35). The individualtherapeutic course was consisted of5days. The clinical efficacy(symptom,sputum volume, pulmonary signs), the pulmonary function (FEV1%pred,FEV1/FVC%), blood gas analysis (PH, PaO2, PaCO2), inflammatory cytokines(IL-8, TNF-α), inpatient time and fasting plasma glucose were comparedbetween the before and after treatment, between the three groups.Results:1. The clinical efficacy: Compared with the control group, the symptomdecreased significantly in the inhalation group and the intravenous groupafter the treatment (both P＜0.05). Differences between two groups were nostatistically significant (P＞0.05).2. Lung function: After the treatment, the FEV1%pred and FEV1/FVC%wereimproved in the three groups (both P＜0.05). Compared with the controlgroup, 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. Blood gas analysis: The PH, PaO2and PaCO2after the treatment wereimproved in all groups (both P＜0.05), with a greater magnitude ofimprovement in the inhalation group and the intravenous group (both P＜0.05). Differences between two groups were no statistically significant (P＞0.05).4. Inflammatory cytokines: The level of IL-8and TNF-αafter the treatmentwere improved in the three groups (both P＜0.05). Compared with thecontrol group, there was significant difference (both P＜0.05) in theinflammatory cytokines level in the inhalation group and the intravenousgroup after the treatment respectively. Differences between the two groupswere no statistically significant (P＞0.05).5. Inpatient time: The inhalation group and the intravenous group could shortthe inpatient time significantly compared with the control group (both P＜0.05). Differences between these two groups were no statisticallysignificant (P＞0.05).6. Fasting plasma glucose: Blood glucose level of all the three groups after thetreatment had significantly increased, The level of the intravenous groupincreased higher than the other two groups (both P＜0.05), but thedifferences between the control group and the inhalation group were nosignificant (P＞0.05). 7. Other side effect: Compared with the control group, the incidence of adversereactions of the other two groups was significant difference (both P＜0.05),and the intravenous group was significantly higher than the inhalation group(P＜0.05).Conclusion:1. Glucocorticoid may improve the clinical symptom, lung function, hypoxemiaand shorten inpatient time of elderly AECOPD patients.2. Inhalation glucocorticoid is as effective as the intravenous group incontrolling airway inflammation of elderly AECOPD patients.3. Nebulized glucocorticoid is recommended for the treatment of elderlyAECOPD patients because it is as effective as the intravenous group and thesystemic adverse is quite small. |
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