Assessment of high-dose inhalational corticosteroids vs systemic corticosteroids in acute exacerbations of COPD in diabetic patients

Background Systemic corticosteroids (SCS) are effective in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, they are not without adverse effects, especially hyperglycemia. Inhaled corticosteroids (ICS) showed satisfactory outcomes with good safety. These benefits were not evaluated in patients with AECOPD with diabetes mellitus. The aim was to compare the efficacy and safety of high dose of ICS vs SCS in the treatment of AECOPD in diabetic patients. Patients and methods A total of 126 patients with AECOPD were screened, and thirty of them were found to be eligible and were enrolled into two groups: group 1 (n=15) received 1 mg budesonide by jet nebulizer four times daily, and group 2 (n=15) received 40 mg prednisolone or equivalent systemically. Postbronchodilator forced expiratory volume in 1 s (FEV1%) of predicted was measured at day 1 and day 7, and random blood sugar (RBG) was measured twice daily in all patients. Results There was a significant increase in the mean FEV1 at day 7 as compared with mean FEV1 at day 1 in groups 1 and 2, with the increase in mean FEV1 being 19.6 and 21% in groups 1 and 2, respectively. There was a significant difference, with higher mean RBG in group 2 when compared with group 1, at day 4 of treatment and continued onward. Interestingly, there was a significant elevation in mean RBG among patients in group 2 (SCS) starting by day 3 of treatment and continued onward, with no significant rise in the first two days, although there was no evident effect of ICS on the mean RBG among patients in group 1 (ICS) during the follow-up days. Conclusion Both ICS and SCS improve airflow in patients with AECOPD, taking into consideration the existence of diabetes mellitus. ICS may be an excellent substitute to SCS in the treatment of AECOPD in diabetic patients.