ABSTRACT
Corticosteroids used for chronic obstructive pulmonary disease [COPD] exacerbations can cause hyperglycemia in hospitalized patients, and hyperglycemia may be associated with increased mortality, length of stay [LOS], and re-admissions in these patients. We did three retrospective studies using charts from July 2008 through June 2009, January 2006 through December 2010, and October 2010 through March 2011. We collected demographic and clinical information, laboratory results, radiographic results, and information on LOS, mortality, and re-admission. Glucose levels did not predict outcomes in any of the studied cohorts, after adjustment for covariates in multivariable analysis. The first database included 30 patients admitted to non-intensive care unit [ICU] hospital beds. Six of 20 non-diabetic patients had peak glucoses above 200 mg/dl. Nine of the ten diabetic patients had peak glucoses above 200 mg/dl. The maximum daily corticosteroid dose had no apparent effect on the glucose levels. The second database included 217 patients admitted to ICUs. The initial blood glucose was higher in patients who died than those who survived using bivariate analysis [P= 0.015; odds ratio, OR, 1.01] but not in multivariable analysis. Multivariable logistic regression analysis also demonstrated that glucose levels did not affect LOS. The third database analyzing COPD re-admission rates included 81 patients; the peak glucose levels were not associated with re-admission. Our data demonstrate that COPD patients treated with corticosteroids developed significant hyperglycemia, but the increase in blood glucose levels did not correlate with the maximum dose of corticosteroids. Blood glucose levels were not associated with mortality, LOS, or re-admission rates
ABSTRACT
Pulmonary rehabilitation [PR] has inconsistent effects on health-related quality of life [HRQL] in patients with chronic lung diseases. We evaluated the effect of PR on HRQL outcomes using the 36-item short form of the medical outcomes [SF-36]. We retrospectively reviewed the files of all patients who completed PR in 2010, 2011, and first half of 2012. We collected information on demographics, symptoms, pulmonary function tests, 6-minute walk tests [6-MWT], and responses on the SF-36 survey, including the physical component score [PCS] and mental component score [MCS]. The study included 19 women and 22 men. The mean age was 69.8 +/- 8.5 years. The diagnoses included chronic obstructive pulmonary disease [COPD; n = 31], asthma [n = 3], interstitial lung disease [n = 5], and obstructive sleep apnea [OSA; n = 2]. The mean forced expiratory volume-one second [FEV1] was 1.16 +/- 0.52 L [against 60.5 +/- 15.9% of predicted value]. There was a significant improvement in 6-MWT [P < 0.0001]. The PCS improved post-PR from 33.8 to 34.5 [P = 0.02]; the MCS did not change. These patients had low SF-36 scores compared to the general population; changes in scores after PR were low. These patients may need frequent HRQL assessment during rehabilitation, and PR programs should consider program modification in patients with small changes in mental health