Systemic Corticosteroids Fail to Benefit Patients with AECOPD & Pneumonia

With the 2018-19 influenza (flu) season in full swing, patients with asthma, chronic obstructive pulmonary disease (COPD) and other lung conditions are at a higher risk of developing pneumonia and other respiratory diseases.

Given that heightened risk, it is not only important to consider the efficacy of preventative measures, such as flu and pneumococcal vaccines, it is imperative that the efficacy of treatment is examined as well.

Until recently, studies of systemic corticosteroids in pneumonia have yielded contradicting results while studies in acute exacerbation of COPD have shown significant benefits, leaving a shaky foundation, at best, upon which to examine the validity of this specific treatment method.

COPD, a leading cause of morbidity and mortality worldwide, put patients at an increased pneumonia due to impaired lung defenses and possibly inhaled corticosteroid use, according to the US Centers for Disease Control and Prevention (CDC). Additionally, pneumonia is the leading cause of death from infectious disease in the United States.

Systemic corticosteroids are standard of care in the management of an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Studies have suggested that this method of treatment improves short-term lung function and reduces treatment failure rates, 30-day relapse, and length of hospital stay. However, analysis examining the effectiveness of systemic corticosteroid therapy in an AECOPD have historically excluded patients with pneumonia.

A recent study which sought to break that cycle and determine the efficacy of systemic corticosteroids in patients’ pneumonic and non-pneumonic AECOPD suggests the drug may not provide a clinical benefit to patients with pneumonic acute exacerbation of COPD.

The study, led by Dr. Alizamin Sadigov, of the Azerbaijan Medical University, determined that systemic corticosteroids may lead to “the worsening of clinical features of the exacerbation course and increased risk of ICU admission and mortality in patients with pneumonic AECOPD.”

Investigators followed patients with a diagnosis of COPD with exacerbation and pneumonia between November 1, 2011 and February 28, 2016. Each patient received systemic corticosteroids, the efficacy of which was assessed in pneumonic and non-pneumonic AECOPD.

The results of the study showed increased length of hospital stays in patients with pneumonic AECOPD, and more frequent in-hospital treatment failure was also seen in patients with pneumonic AECOPD.

Additionally, ICU admission caused by respiratory failure required invasive and non-invasive ventilation and septic shock was reported more frequently by patients with pneumonic ACCOPD. The 30-day re-admission rate was also higher among this group as was the 30-day mortality rate, according to the study.

Given the significance of these findings, this study proves useful for a myriad of specialists who work with patients diagnosed with COPD and pneumonia, such as respiratory therapists, ICU physicians, nurses and pulmonologists.

The study’s authors could not be reached for comment.

The study, "Evaluation of Systemic Corticosteroids in Patients With an Acute Exacerbation of COPD and a Diagnosis of Pneumonia," was published online by the Journal of the COPD Foundation.