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Применение глюкокортикоидов при обострении хронической обструктивной болезни легких
Применение глюкокортикоидов при обострении хронической обструктивной болезни легких
Кароли Н.А., Ребров А.П. Применение глюкокортикоидов при обострении хронической обструктивной болезни легких. Consilium Medicum. 2016; 18 (3): 59–64. DOI: 10.26442/2075-1753_2016.3.59-64
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Аннотация
Хроническая обструктивная болезнь легких (ХОБЛ) – это прогрессирующее заболевание, характеризующееся высокой смертностью. Благодаря постоянно растущему социальному и экономическому бремени значительное внимание уделяется оптимальному ведению пациентов с ХОБЛ и связанных с ней обострений. В настоящее время глюкокортикоиды (ГК) остаются стандартом лечения для обострений ХОБЛ, что основано на их документированной эффективности в снижении выраженности бронхообструкции, улучшении газообмена (повышение объема форсированного выдоха за 1-ю секунду и PaO2), а также в уменьшении одышки, снижении сроков госпитализации и процента рецидивов в течение ближайших 30 дней. Пероральные ГК более предпочтительны, чем парентеральные, как в плане стоимости, так и простоты применения. Ингаляционные ГК могут применяться при нетяжелых обострениях ХОБЛ в качестве альтернативы системным стероидам, пока не будут получены данные других исследований.
Несмотря на отсутствие крупных рандомизированных контролируемых исследований, имеющиеся данные поддерживают более короткий срок лечения ГК, чем ранее рекомендованный 10–14-дневный курс терапии. В частности, результаты недавно опубликованного рандомизированного двойного слепого плацебо-контролируемого исследования свидетельствуют, что 5-дневный курс системных ГК демонстрировал не меньшую эффективность, чем традиционная 14-дневная схема лечения. Учитывая эти данные, вполне вероятно, многие пациенты необоснованно подвергаются негативному воздействию более продолжительного курса лечения ГК.
Необходимо отметить, что в отношении применения ГК при обострениях ХОБЛ ряд вопросов так и остаются открытыми. Так, например, отсутствуют исследования по непосредственному сравнению разных ГК и режимов их применения у пациентов с разной тяжестью обострений ХОБЛ.
Ключевые слова: хроническая обструктивная болезнь легких, обострение, глюкокортикоиды.
Несмотря на отсутствие крупных рандомизированных контролируемых исследований, имеющиеся данные поддерживают более короткий срок лечения ГК, чем ранее рекомендованный 10–14-дневный курс терапии. В частности, результаты недавно опубликованного рандомизированного двойного слепого плацебо-контролируемого исследования свидетельствуют, что 5-дневный курс системных ГК демонстрировал не меньшую эффективность, чем традиционная 14-дневная схема лечения. Учитывая эти данные, вполне вероятно, многие пациенты необоснованно подвергаются негативному воздействию более продолжительного курса лечения ГК.
Необходимо отметить, что в отношении применения ГК при обострениях ХОБЛ ряд вопросов так и остаются открытыми. Так, например, отсутствуют исследования по непосредственному сравнению разных ГК и режимов их применения у пациентов с разной тяжестью обострений ХОБЛ.
Ключевые слова: хроническая обструктивная болезнь легких, обострение, глюкокортикоиды.
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Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by a high mortality rate. Due to the ever-growing social and economic burden, considerable attention is paid to the optimal management of patients with COPD and related exacerbations. Currently glucocorticoid (GC) remains the standard treatment for COPD exacerbations, that is based on their documented efficacy in reducing the severity of bronchial, improving gas exchange (increased forced expiratory volume in 1 second and PaO2), as well as dyspnea, decreased hospital stays and the percentage relapse over the next 30 days. Oral GC preferred over parenteral, both in terms of cost and ease of use. Inhaled GC can be used in non-severe exacerbations of COPD as an alternative to systemic steroid until other studies will be obtained.
Despite the absence of large randomized controlled studies, the available data support a shorter period of treatment GK than previously recommended by the 10–14-day course of therapy. In particular, the results of a recently published randomized, double-blind, placebo-controlled studies have shown that 5-day course of systemic GC showed no less effective than the traditional 14-day regimen. Given these data, it is likely many patients are unnecessarily exposed to the negative impact of a longer course of treatment GK.
It should be noted that the application of the Civil Code in exacerbations of COPD, a number of issues still remain open. For example, there are no studies on the direct comparison of different modes of HA and their use in patients with varying severity of exacerbations of COPD.
Key words: chronic obstructive pulmonary disease, exacerbation, glucocorticoids.
Despite the absence of large randomized controlled studies, the available data support a shorter period of treatment GK than previously recommended by the 10–14-day course of therapy. In particular, the results of a recently published randomized, double-blind, placebo-controlled studies have shown that 5-day course of systemic GC showed no less effective than the traditional 14-day regimen. Given these data, it is likely many patients are unnecessarily exposed to the negative impact of a longer course of treatment GK.
It should be noted that the application of the Civil Code in exacerbations of COPD, a number of issues still remain open. For example, there are no studies on the direct comparison of different modes of HA and their use in patients with varying severity of exacerbations of COPD.
Key words: chronic obstructive pulmonary disease, exacerbation, glucocorticoids.
Полный текст
Список литературы
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27. Gunen H, Hacievliyagil SS, Yetkin O et al. The role of nebulised budesonide in the treatment of exacerbations of COPD. Eur Respir J 2007; 29: 660–7.
28. Johansson SA, Andersson KE, Brattsand R et al. Topical and systemic glucocorticoid potencies of budesonide, beclomethasone dipropionate and prednisolone in man. Eur J Respir Dis (Suppl.) 1982; 122: 74–82.
29. Brogden RN, McTavish D. Budesonide: an updated review of its pharmacological properties and therapeutic efficacy in asthma and rhinitis. Drugs 1992; 44: 375–407.
30. Maltais F, Ostinelli J, Borbeau J et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease; a randomized controlled trial. Am J Respir Crit Care Med 2002; 165: 698–703.
2. Lopez AD, Shibuya K, Rao C et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397–412.
3. Global Strategy for diagnosis, management and prevention of COPD. Scientific information and recommendations for COPD programs. Updated 2013. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013Feb13.pdf
4. Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. ERJ 2007; 29: 1224–38.
5. Abroug F, Ouanes I, Abroug S et al. Systemic corticosteroids in acute exacerbation of COPD: a meta-analysis of controlled studies with emphasis on ICU patients. Ann Intensive Care 2014; 26 (4): 32.
6. Woods JA, Wheeler JS, Finch CK, Pinner NA. Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9: 421–30.
7. Federal'nye klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskoi obstruktivnoi bolezni legkikh. 2014; http://pulmonology.ru/publications/guide.php / [in Russian]
8. Cai BQ, Cai SX, Chen RC et al. Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People's Republic of China. Int J Chron Obstruct Pulmon Dis 2014; 9: 381–95. doi: 10.2147/COPD.S58454. eCollection 2014. Review.
9. Cheng T, Gong Y, Guo Y et al. Systemic corticosteroid for COPD exacerbations, whether the higher dose is better? A meta-analysis of randomized controlled trials. Clin Respir J 2013; 7 (4): 305–18. doi: 10.1111/crj.12008. Epub 2012 Nov 28. Review.
10. Kiser TH, Allen RR, Valuck RJ et al. Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 189 (9): 1052–64.
11. Bafadhel M, Davies L, Calverley PM et al. Blood eosinophil guided prednisolone therapy for exacerbations of COPD: a further analysis. Eur Respir J 2014; 44 (3): 789–91. doi: 10.1183/09031936.00062614.
12. Walters JA, Tan DJ, White CJ et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; 9: CD001288. doi: 10.1002/14651858.CD001288.pub4. Review.
13. Singh JM, Palda VA, Stanbrook MB, Chapman KR. Corticosteroid therapy for patients with acute exacerbations of chronic obstructive pulmonary disease: a systematic review. Arch Intern Med 2002; 162: 2527–36.
14. Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract 2009; 15: 469–74.
15. Habib G, Dar-Esaif Y, Bishara H et al. The impact of corticosteroid treatment on hemoglobin A1C levels among patients with type-2 diabetes with chronic obstructive pulmonary disease exacerbation. Respir Med 2014; 108 (11): 1641–6.
16. Vondracek S, Hemstreet BA. Retrospective evaluation of systemic corticosteroids for the management of acute exacerbations of chronic obstructive pulmonary disease. Am J Helath Syst Pharm 2006; 63: 645–52.
17. Warrington TP, Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clin Proc 2006; 81: 1361–7.
18. Schuetz P, Christ-Crain M, Schild U et al. Effect of a 14-day course of systemic corticosteroids on the hypothalamic pituitary-adrenal-axis in patients with acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 2008; 8: 1.
19. Buchman AL. Side Effects of Corticosteroid Therapy. J Clin Gastroenterol 2001; 33: 289–94.
20. Schuets P, Leuppi JD, Tamm M et al. Short versus conventional term glucocorticoid therapy in acute exacerbation of chronic obstructive pulmonary disease. Swiss Med Wkly 2010; 140: w13109
21. Sayiner A, Aytemur ZA, Cirit M, Unsal I. Systemic glucocorticoids in severe exacerbations of COPD. Chest 2001; 119: 726–30.
22. Leuppi JD, Schuetz P, Bingisser R et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013; 309: 2223–31.
23. Niewoehner DE, Erbland ML, Deupree RH et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med 1999; 340: 1941–7.
24. Walters JA, Tan DJ, White CJ, Wood-Baker R. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; 12: CD006897. doi: 10.1002/14651858.CD006897.pub3. Review.
25. de Jong YP, Uil SM, Grotjohan HP et al. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest 2007; 132: 1741–7.
26. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update). 2010. http://guidance.nice.org.uk/cg101. Accessed March 17, 2014.
27. Gunen H, Hacievliyagil SS, Yetkin O et al. The role of nebulised budesonide in the treatment of exacerbations of COPD. Eur Respir J 2007; 29: 660–7.
28. Johansson SA, Andersson KE, Brattsand R et al. Topical and systemic glucocorticoid potencies of budesonide, beclomethasone dipropionate and prednisolone in man. Eur J Respir Dis (Suppl.) 1982; 122: 74–82.
29. Brogden RN, McTavish D. Budesonide: an updated review of its pharmacological properties and therapeutic efficacy in asthma and rhinitis. Drugs 1992; 44: 375–407.
30. Maltais F, Ostinelli J, Borbeau J et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease; a randomized controlled trial. Am J Respir Crit Care Med 2002; 165: 698–703.
2. Lopez AD, Shibuya K, Rao C et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397–412.
3. Global Strategy for diagnosis, management and prevention of COPD. Scientific information and recommendations for COPD programs. Updated 2013. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013Feb13.pdf
4. Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. ERJ 2007; 29: 1224–38.
5. Abroug F, Ouanes I, Abroug S et al. Systemic corticosteroids in acute exacerbation of COPD: a meta-analysis of controlled studies with emphasis on ICU patients. Ann Intensive Care 2014; 26 (4): 32.
6. Woods JA, Wheeler JS, Finch CK, Pinner NA. Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9: 421–30.
7. Федеральные клинические рекомендации по диагностике и лечению хронической обструктивной болезни легких. 2014; http://pulmonology.ru/publications/guide.php / Federal'nye klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskoi obstruktivnoi bolezni legkikh. 2014; http://pulmonology.ru/publications/guide.php / [in Russian]
8. Cai BQ, Cai SX, Chen RC et al. Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People's Republic of China. Int J Chron Obstruct Pulmon Dis 2014; 9: 381–95. doi: 10.2147/COPD.S58454. eCollection 2014. Review.
9. Cheng T, Gong Y, Guo Y et al. Systemic corticosteroid for COPD exacerbations, whether the higher dose is better? A meta-analysis of randomized controlled trials. Clin Respir J 2013; 7 (4): 305–18. doi: 10.1111/crj.12008. Epub 2012 Nov 28. Review.
10. Kiser TH, Allen RR, Valuck RJ et al. Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 189 (9): 1052–64.
11. Bafadhel M, Davies L, Calverley PM et al. Blood eosinophil guided prednisolone therapy for exacerbations of COPD: a further analysis. Eur Respir J 2014; 44 (3): 789–91. doi: 10.1183/09031936.00062614.
12. Walters JA, Tan DJ, White CJ et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; 9: CD001288. doi: 10.1002/14651858.CD001288.pub4. Review.
13. Singh JM, Palda VA, Stanbrook MB, Chapman KR. Corticosteroid therapy for patients with acute exacerbations of chronic obstructive pulmonary disease: a systematic review. Arch Intern Med 2002; 162: 2527–36.
14. Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract 2009; 15: 469–74.
15. Habib G, Dar-Esaif Y, Bishara H et al. The impact of corticosteroid treatment on hemoglobin A1C levels among patients with type-2 diabetes with chronic obstructive pulmonary disease exacerbation. Respir Med 2014; 108 (11): 1641–6.
16. Vondracek S, Hemstreet BA. Retrospective evaluation of systemic corticosteroids for the management of acute exacerbations of chronic obstructive pulmonary disease. Am J Helath Syst Pharm 2006; 63: 645–52.
17. Warrington TP, Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clin Proc 2006; 81: 1361–7.
18. Schuetz P, Christ-Crain M, Schild U et al. Effect of a 14-day course of systemic corticosteroids on the hypothalamic pituitary-adrenal-axis in patients with acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 2008; 8: 1.
19. Buchman AL. Side Effects of Corticosteroid Therapy. J Clin Gastroenterol 2001; 33: 289–94.
20. Schuets P, Leuppi JD, Tamm M et al. Short versus conventional term glucocorticoid therapy in acute exacerbation of chronic obstructive pulmonary disease. Swiss Med Wkly 2010; 140: w13109
21. Sayiner A, Aytemur ZA, Cirit M, Unsal I. Systemic glucocorticoids in severe exacerbations of COPD. Chest 2001; 119: 726–30.
22. Leuppi JD, Schuetz P, Bingisser R et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013; 309: 2223–31.
23. Niewoehner DE, Erbland ML, Deupree RH et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med 1999; 340: 1941–7.
24. Walters JA, Tan DJ, White CJ, Wood-Baker R. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; 12: CD006897. doi: 10.1002/14651858.CD006897.pub3. Review.
25. de Jong YP, Uil SM, Grotjohan HP et al. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest 2007; 132: 1741–7.
26. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update). 2010. http://guidance.nice.org.uk/cg101. Accessed March 17, 2014.
27. Gunen H, Hacievliyagil SS, Yetkin O et al. The role of nebulised budesonide in the treatment of exacerbations of COPD. Eur Respir J 2007; 29: 660–7.
28. Johansson SA, Andersson KE, Brattsand R et al. Topical and systemic glucocorticoid potencies of budesonide, beclomethasone dipropionate and prednisolone in man. Eur J Respir Dis (Suppl.) 1982; 122: 74–82.
29. Brogden RN, McTavish D. Budesonide: an updated review of its pharmacological properties and therapeutic efficacy in asthma and rhinitis. Drugs 1992; 44: 375–407.
30. Maltais F, Ostinelli J, Borbeau J et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease; a randomized controlled trial. Am J Respir Crit Care Med 2002; 165: 698–703.
________________________________________________
2. Lopez AD, Shibuya K, Rao C et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J 2006; 27: 397–412.
3. Global Strategy for diagnosis, management and prevention of COPD. Scientific information and recommendations for COPD programs. Updated 2013. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2013Feb13.pdf
4. Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. ERJ 2007; 29: 1224–38.
5. Abroug F, Ouanes I, Abroug S et al. Systemic corticosteroids in acute exacerbation of COPD: a meta-analysis of controlled studies with emphasis on ICU patients. Ann Intensive Care 2014; 26 (4): 32.
6. Woods JA, Wheeler JS, Finch CK, Pinner NA. Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9: 421–30.
7. Federal'nye klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskoi obstruktivnoi bolezni legkikh. 2014; http://pulmonology.ru/publications/guide.php / [in Russian]
8. Cai BQ, Cai SX, Chen RC et al. Expert consensus on acute exacerbation of chronic obstructive pulmonary disease in the People's Republic of China. Int J Chron Obstruct Pulmon Dis 2014; 9: 381–95. doi: 10.2147/COPD.S58454. eCollection 2014. Review.
9. Cheng T, Gong Y, Guo Y et al. Systemic corticosteroid for COPD exacerbations, whether the higher dose is better? A meta-analysis of randomized controlled trials. Clin Respir J 2013; 7 (4): 305–18. doi: 10.1111/crj.12008. Epub 2012 Nov 28. Review.
10. Kiser TH, Allen RR, Valuck RJ et al. Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014; 189 (9): 1052–64.
11. Bafadhel M, Davies L, Calverley PM et al. Blood eosinophil guided prednisolone therapy for exacerbations of COPD: a further analysis. Eur Respir J 2014; 44 (3): 789–91. doi: 10.1183/09031936.00062614.
12. Walters JA, Tan DJ, White CJ et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2014; 9: CD001288. doi: 10.1002/14651858.CD001288.pub4. Review.
13. Singh JM, Palda VA, Stanbrook MB, Chapman KR. Corticosteroid therapy for patients with acute exacerbations of chronic obstructive pulmonary disease: a systematic review. Arch Intern Med 2002; 162: 2527–36.
14. Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract 2009; 15: 469–74.
15. Habib G, Dar-Esaif Y, Bishara H et al. The impact of corticosteroid treatment on hemoglobin A1C levels among patients with type-2 diabetes with chronic obstructive pulmonary disease exacerbation. Respir Med 2014; 108 (11): 1641–6.
16. Vondracek S, Hemstreet BA. Retrospective evaluation of systemic corticosteroids for the management of acute exacerbations of chronic obstructive pulmonary disease. Am J Helath Syst Pharm 2006; 63: 645–52.
17. Warrington TP, Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clin Proc 2006; 81: 1361–7.
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Авторы
Н.А.Кароли, А.П.Ребров*
ГБОУ ВПО Саратовский государственный медицинский университет им. В.И.Разумовского Минздрава России. 410012, Россия, Саратовская область, Саратов, ул. Большая Казачья, д. 112
*andreyrebrov@yandex.ru
ГБОУ ВПО Саратовский государственный медицинский университет им. В.И.Разумовского Минздрава России. 410012, Россия, Саратовская область, Саратов, ул. Большая Казачья, д. 112
*andreyrebrov@yandex.ru
________________________________________________
N.A.Karoli, A.P.Rebrov*
Saratov State Medical University. 410012, Russian Federation, Saratovskaia oblast', Saratov, ul. Bol'shaia Kazach'ia, d. 112
*andreyrebrov@yandex.ru
Saratov State Medical University. 410012, Russian Federation, Saratovskaia oblast', Saratov, ul. Bol'shaia Kazach'ia, d. 112
*andreyrebrov@yandex.ru
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