Steroids for treatment of COPD exacerbations: Less is clearly more

摘要

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) is a common, progressive lung condition, characterized by cough and dyspnea and punctuated by episodes of acute exacerbations or "lung attacks" during which these symptoms significantly increase. These lung attacks can induce severe symptoms, causing patients to seek urgent medical care and can result in respiratory failure and death. In the United States, COPD exacerbations are responsible for more than 800 000 hospital admissipns each year and 143 000 deaths annually, making it the third leading cause of mortality. Furthermore, acute exacerbations accelerate decline in lung function, reduce patients' quality of life, and increase health care use (with exacerbation management accounting for up to 70% of the total direct costs of COPD management). Acute exacerbations are common among patients with COPD, with nearly 1 in 2 patients experiencing at least exacerbation annually. Although the pathophysiology of exacerbations is poorly understood, in most cases, it is thought to be provoked by an acute respiratory tract infection (by either a virus or bacteria), which suborns a hyperinflam-matory state in the airways, causing patients to experience paroxysms of cough, sputum production, and shortness of breath.