Clinical Study Of Aerosol Inhalation Corticosteroids For The Treatment Of AECOPD Patients With Non-Hypercapnia

Objective:1.To compare the efficacy and safety of inhaled corticosteroids and systemic corticosteroids in patients with AECOPD with Non-hypercapnia,and to explore the optimal dose of inhaled corticosteroids was discussed.2.To investigate the realtion between blood eosinophil and inhaled corticosteroids in these patients,and to determine the optimal number of blood eosinophils.Methods:1.In this study,103 patients of AECOPD with non-hypercapnia who were treated in our hospital from May 2015 to May 2017 were selected as the main subjects.All the basic data of all patients are in accordance with the inclusion criteria of this study.2.Patients were randomly divided into four groups.Group A received nebulizde budnesonide(NB)inhalation(2mg/12h),group B received NB inhalation(2mg/8h),group C received NB inhalation(2mg/6h),group D used systemic medicationmethylprednisolone treatment(40mg/24h).All the selected patients received standard treatment,including antibiotics,nebulized ?-agonist,theophylline and other medications,and supplemental oxygen.The total effective rate,clinical symptom remission time,hospitalization time,COPD Assessment Test(CAT),total hospital expenses,and adverse events were analyzed and compared between the four groups.3.To determine the optimal critical value of eosinophilic granulocytes according to the therapeutic effect.Result:A total of 103 patients were enrolled in the study.We analyzed the age,sex,fastingblood glucose,CAT and mMRC of patients at admission of four groups,The differences were not statistically significant in the four groups(P<0.05).1.Symptom score:Aftertreatment,the CAT?mMRC?symptom scores of VAS were all significantly lower than before treatment(P<0.05)and those of B,C,D were significantly lower than A group(P<0.05),and there was no statistical significance between the group B,C and D.2.Effective,Clinical remission time:For the effective rates,the group A was significantly lower than other thress groups(P<0.05),but there was no significant difference between other three groups(P>0.05).At the time of discharge,Clinical remission time of group A was significant higher than other three groups(P<0.05).3.Adverse reactions:After the treatment,the levels of fasting blood glucose in the four groups had significantly in creased(all P<0.05).The level of the D group increased higher than the other three groups(P<0.05).But the differences between the other three groups were no statistically significant(P>0.05).Other adverse reactions occurred in four groups,and the incidence of adverse reaction was highest in the D group.The incidence of adverse reaction of the group D increased higher than the other three groups(P<0.05),but the differences between other three groups were no statistically significant.4.Hospitalization time and treatment cost:In the Hospitalization time,the median of the group A was higher than other three groups,and the difference was statistically significant.In the treatment cost,we found that group C was the highest,and there were statistically significant differences compared with the other three groups(P<0.05).5.Blood eosinophil:Since the patients in group B and group C were equal in clinical efficacy,clinical relief time,CAT score and mMRC score,the ROC diagram was drawn after combining group B and group C.By the ROC curve,the patients whose blood eosinophil was greater than 2%are more sensitive to aerosol inhalation corticosteroids.6.Followed up:Patients were followed up on the 30th day after discharge from the hospital.There was no statistically significant difference between the four groups on acute exacerbation.The CAT score and mMRC score of Group A was higher than those of group B,C and D,and the difference was statistically significant(P<0.05).conclusion:1.Inhalation of high dose aerosol inhalation corticosteroids in AECOPD patients with non-hypercapnia can be used as an alternative treatment for systemic corticosteroids.We recommend 6mg/day.Compared with the systemic corticosteroids,the aerosol inhalation corticosteroids has less effect on fasting blood glucose and less adverse reactions.2.1n AECOPD patients with non-hypercapnia,blood eosinophils can be used as a marker of aerosol inhalation corticosteroids.Patients with blood-eosinophilic>2%were more sensitive to aerosol inhalation corticosteroids therapy.