Comparison Of Effects Of Aerosol Inhalation And Intravenous Glucocorticoid In Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective:The aerosolized administration of glucocorticoids has been used in the treatment of various lung diseases.The efficacy of aerosolized administration of GC in chronic obstructive pulmonary disease is still unclear.For patients with frequent acute exacerbations of AECOPD,the treatment of GC needs to be more cautious.Therefore,the purpose of this study is to observe the local atomization use of glucocorticoids and intravenous systemic use of GC in the treatment of patients with frequent acute exacerbations of AECOPD,comparing the two modes of administration in improving clinical symptoms and reducing inflammatory markers,short-term prognosis,and affecting fasting blood glucose Is there a difference?Methods:A randomized,single-blind,prospective study which enrolled 60 patients with AECOPD who had been hospitalized 2 or more times a year.A set of random numbers was generated by the system,the even number was determined as the local nebulized inhalation GC treatment group,and the odd number was determined as the intravenous systemic GC treatment group.The nebulized group was inhaled with Budesonide suspension（1 mg/branch）3mg,2 times a day for 5 days,and 2 mg once per night for 5 days.Intravenous group was given Methylprednisolone sodium succinate（40 mg/ampoules）40 mg intravenous bolus once a day for 5 days.In addition to the above interventions,the two groups of patients were treated with conventional treatment for AECOPD,including:bronchodilator:Combivent（500ug/support）500ug combined with Terbutaline sulphate（5mg/support）2.5mg nebulized,2 times a day;Doxofylline（0.3g/ampoules）0.3g intravenously,once a day;tincture:Bromhexine hydrochloride（4mg/ampoules）8mg Intravenous bolus injection,2 times a day;anti-infection:select appropriate antibiotics according to different patient conditions,and the lung function（recorded indicators include FEV1/FVC,FEV1%pred）,CAT questionnaire score（Self-assessment test questionnaire for patients with chronic obstructive pulmonary disease）,arterial blood gas analysis（recorded indicators are pH,PaCO₂,PaO₂）,C-reactive protein（CRP）,procalcitonin（PCT）,Interleukin-6（IL-6）,fasting blood glucose,hospitalization rate within 6 weeks after discharge,hospitalization time of patients before and after 5 days of treatment by GC were recorded.Results:The lung function（FEV1/FVC,FEV1%pred）,CAT questionnaire score,arterial blood gas analysis（pH,PaCO2,PaO2）,CRP,PCT,IL-6 in the both group were compared before and after treatment,and the differences were statistically significant（P<0.05）.Comparison of FEV1/FVC,FEV11%pred,CAT questionnaire score,pH,PaCO₂,PaO₂,CRP,PCT,IL-6,acute exacerbation rate within 6 weeks,and hospitalization time in the nebulized group and that in the intravenous group after treatment,the difference was not statistically significant（P>0.05）.The fasting blood glucose level in the nebulized group was higher than that in the fasting blood glucose level before treatment,but the difference was not statistically significant（P>0.05）.The fasting blood glucose level in the intravenous group was higher than that in the fasting blood glucose level before treatment,and the difference was statistically significant（P<0.05）.The fasting blood glucose level after treatment in the intravenous group was significantly higher than that in the nebulized group,and the difference was statistically significant（P<0.05）.Conclusion:In patients with frequent acute exacerbation of chronic obstructive pulmonary disease,local aerosol inhalation of GC and intravenous GC treatment can effectively alleviate clinical symptoms,inhibit airway inflammation,and local aerosol inhalation of GC and intravenous GC,and the same effect can be achieved.In terms of the effect on fasting blood glucose levels,the use of GC for local nebulization has a smaller effect on fasting blood glucose in patients compared to systemic intravenous GC.