Table of Contents
ISRN Pulmonology
Volume 2011, Article ID 157693, 6 pages
http://dx.doi.org/10.5402/2011/157693
Research Article

Outcomes of COPD Exacerbations Treated with Corticosteroids, Antibiotics, or Both

Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, 745 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA

Received 14 June 2011; Accepted 10 July 2011

Academic Editors: A. Michalopoulos and E. Vollmer

Copyright © 2011 Christopher B. Remakus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. The outcomes for outpatient treatment of acute exacerbations of COPD (AECOPD) are poorly described. Design. The results of a daily diary recording symptoms and peak flows were compiled into a severity score to trigger algorithm-based treatments and a symptom index to follow treatment response. Treatment failure (symptom index failing to return to baseline for 2 consecutive days or hospitalization within 21 days) was the main outcome. Results. Twenty-two patients (FEV1 0.81 ± 0.26 L) were treated for 115 AECOPDs (corticosteroids = 36, antibiotics = 41, corticosteroids/antibiotics = 38). Treatment failure was 50% for the corticosteroid/antibiotic compared to 28% ( 𝑃 = 0 . 0 0 6 ) for the corticosteroid and 34% ( 𝑃 < 0 . 0 0 0 1 ) for the antibiotic group. Patients suffering from AECOPDs treated with corticosteroids had dyspnea, wheezing, and decreased peak flow; those treated with antibiotics had sputum symptoms; those treated with corticosteroids/antibiotics had dyspnea, wheezing, sputum symptoms, and decreased peak flows. Conclusions. AECOPDs with both dyspnea and sputum symptoms are more refractory to standard treatment and likely require closer monitoring.