Evaluation of Risks versus Benefits with Concomitant Use of Budesonide Nebulizers and Systemic Corticosteroids in COPD Exacerbations

: Background: Systemic corticosteroids are recommended for treatment of chronic obstructive pulmonary disease (COPD) exacerbations. Studies suggest nebulized budesonide may beequivalent to systemic corticosteroids in COPD exacerbations. However, there is limited data on benefits or risks of concomitant nebulized and systemic corticosteroid use during COPD exacerbations. Methods: This was a single-center, retrospective study evaluating subjects admitted with a COPD exacerbation who received systemic corticosteroids with or without nebulized budesonide. Subjects were included if they had a COPD exacerbation, received systemic corticosteroids of at least 40 mg prednisone equivalents daily for at least 48 hours, and received nebulized budesonide for at least 48 hours if in the budesonide arm. Exclusion criteria included subjects with asthma, active cancer or other forms of immunosuppression, recent systemic corticosteroid usage, or active fungal infection(s). The primary outcome was to compare length of stay between treatment groups. Secondary outcomes were to compare adverse effect rates. Results: 645 subject charts were reviewed and 75 subjects were included(n=41 in the budesonide group; n=34 in the non-budesonide group). Length of stay averaged 4.63 and 3.62 days (p = 0.18) in the budesonide and non-budesonide arms, respectively. Hyperglycemic events occurred significantly more often in the budesonide group (n=164 vs. 92 (p = 0.02)) while thrush diagnoses were not significantly different (n=4 vs. 0 (p = 0.12)). Conclusion: Nebulized budesonide in addition to systemic corticosteroids during a COPD exacerbation does not decrease hospital length of stay and significantly increases the risk of hyperglycemic events. A Other shown that nebulized budesonide appears to be equivalent to systemic corticosteroids as and prednisone in improving pulmonary function, forced expiratory volume in 1 second (FEV saturation of peripheral oxygen (SpO 2 ),in reducing symptoms, and treating COPD exacerbations. Recent practice trends within certain institutions have included utilizing nebulized budesonide in addition to systemic corticosteroids during a COPD exacerbation. Currently, only one study has evaluated this particular corticosteroid combination therapy and showed that hospital length of stay was longer in patients receiving both systemic and corticosteroids.