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Prospective analysis of adrenal function in patients with acute exacerbations of COPD : the Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial

Schuetz, Philipp and Leuppi, Jörg D. and Bingisser, Roland and Bodmer, Michael and Briel, Matthias and Drescher, Tilman and Duerring, Ursula and Henzen, Christoph and Leibbrandt, Yolanda and Maier, Sabrina and Miedinger, David and Mueller, Beat and Scherr, Andreas and Schindler, Christian and Stoeckli, Rolf and Viatte, Sebastien and von Garnier, Christophe and Tamm, Michael and Rutishauser, Jonas. (2015) Prospective analysis of adrenal function in patients with acute exacerbations of COPD : the Reduction in the Use of Corticosteroids in Exacerbated COPD (REDUCE) trial. European Journal of Endocrinology, 173 (1). pp. 19-27.

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Official URL: http://edoc.unibas.ch/dok/A6411142

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Abstract

To analyze prospectively the hypothalamic-pituitary-adrenal (HPA) axis and clinical outcome in patients treated with prednisone for exacerbated chronic obstructive pulmonary disease (COPD).; Prospective observational study.; Patients presenting to the emergency department were randomized to receive 40 mg prednisone daily for 5 or 14 days in a placebo-controlled manner. The HPA axis was longitudinally assessed with the 1 μg corticotropin test and a clinical hypocortisolism score at baseline, on day 6 before blinded treatment, at hospital discharge, and for up to 180 days of follow-up. Prednisone was stopped abruptly, irrespective of the test results. Patients discharged with pathological test results received instructions about emergency hydrocortisone treatment.; A total of 311 patients were included in the analysis. Mean basal and stimulated serum total cortisol levels were highest on admission (496±398 and 816±413 nmol/l respectively) and lowest on day 6 (235±174 and 453±178 nmol/l respectively). Pathological stimulation tests were found in 63, 38, 9, 3, and 2% of patients on day 6, at discharge, and on days 30, 90, and 180 respectively, without significant difference between treatment groups. Clinical indicators of hypocortisolism did not correlate with stimulation test results, but cortisol levels were inversely associated with re-exacerbation risk. There were no hospitalizations or deaths as a result of adrenal crisis.; Dynamic changes in the HPA axis occur during and after the treatment of acute exacerbations of COPD. In hypocortisolemic patients who were provided with instructions about stress prophylaxis, the abrupt termination of prednisone appeared safe.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Biostatistics > Biostatistics Frequentist Modelling
UniBasel Contributors:Schindler, Christian and Müller, Beat
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Bio Scienctifica
ISSN:0804-4643
e-ISSN:1479-683X
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:08 Dec 2018 19:43
Deposited On:04 Sep 2015 14:30

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