Chronic obstructive pulmonary disease glucocorticoids

Metabolic alkalosis and respiratory acidosis can occur in patients with chronic obstructive pulmonary disease and respiratory acidosis who are treated with salt restriction, diuretics, and possibly glucocorticoids. 

Fatal Aspergillus myocarditis, probably related to shortterm administration of glucocorticoids, has been described in a 58-year-old man, who had an acute exacerbation of his chronic obstructive pulmonary disease and received oxygen, bronchodilators, omeprazole, co-amoxiclav, and intravenous methylprednisolone 40 mg 8-hourly he died 5 days later and postmortem examination showed a fungal myocarditis (337). 

Mortality associated with glucocorticoid has been retrospectively studied in 556 patients with chronic obstructive pulmonary disease admitted to a rehabilitation center (353). Median survival was 38 months and 280 patients died during follow-up. On multivariate analysis, oral glucocorticoid use at a prednisone equivalent of 10 mg/day without inhaled glucocorticoid was associated with an increased risk of death (RR = 2.34 95% Cl = 1.24, 4.44), and 15 mg/day increased the risk further (RR = 4.03 95% Cl = 1.99, 8.15). The risk of death was not increased in those using 5 mg/day or when patients used any oral dose in combination with inhaled glucocorticoids. 

A number of patients who have persistent airflow obstruction exhibit considerable variation in airways resistance and hence in their benefit from bronchodilators drugs for asthma. It is important to recognise the coexistence of asthma with chronic obstructive pulmonary disease in some patients, and to assess their responses to bronchodilators or glucocorticoids over a period of time (as formal tests of respiratory function may not reliably predict clinical response in this setting). 

A 68-year-old man with chronic obstructive pulmonary disease underwent CT examination of the abdomen with intravenous infusion of iomeprol for suspected hepatocellular carcinoma and 2 hours later developed severe dyspnea. A chest X-ray showed bilateral diffuse shadowing of the lungs and the heart shadow was not enlarged. A diagnosis of non-cardiogenic pulmonary edema was made and he improved with glucocorticoids. 

This discussion includes two topics (1) delivery of bronchodilators and glucocorticoids to patients with asthma and chronic obstructive pulmonary diseases (COPD) and (2) aerosols for the treatment of cystic fibrosis (CF). 

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. New Engl J Med 1999 340 1941-1947. 

The nurse is discharging a client diagnosed with chronic obstructive pulmonary disease (COPD). Which discharge instructions should the nurse provide regarding the client s prescription for prednisone, a glucocorticoid ... 

The client diagnosed with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol), a glucocorticoid, IVP. Which laboratory data would warrant immediate intervention by the nurse ... 

The association between inhaled glucocorticoids and the risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD) was reviewed in SEDA-33 (p. 353) and SEDA-32 (p. 311). This remains a controversial area, and more data have been published. The EIDOS and DoTS descriptions of this putative adverse reaction are shown in Figure 1. 

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