ABSTRACT
Objective To test the hypothesis that nebulised budesonide (NB) might be an alternative to systemic corticosteroids in treatment of patients with exacerbated chronic obstructive pulmonary disease (ECOPD).Methods Patients hospitalised with ECOPD (n = 78) were randomnized into three groups.Group 1 received only standard bronchodilator treatment (SBDT),group 2 received systemic corticosteroids (SC 40 mg methylprednisolone) plus SBDT,and group 3 received nebulised budesonide ( NB 1000 mg budesonide q.i.d.) plus SBDT.Complete blood counts,detailed biochemical analysis,spirometric measurements and arterial blood gas analysis were carried out at admission.In addition,the following were recorded:adverse effects,discharging percentage of patients at 10 day and 15 day after hospitalization,exacerbation and re-hospitalization ratio within 1month after discharge.Results The improvement of SO2,PO2,FEV1 and discharge rates was ( 5.3± 0.9 ) %、(5.9 ±0.4)%、(8.7 ±0.5)% ,(8.1 ±0.8)%,(4.9 ±0.4)% and (7.2 ±0.5)% ,which were higher than that in SBDT group.These indexes were not different between 2 group and 3 group.The fraction of patients discharged on the 10th day and 15th were not different.The deteriorate rate was higher in 1 group than in 2 group and 3 group(P ＜0.05 ).Re-admission ratio in one month is higher in 1 group( 12% ) than in 2 group( 5% ) and 3 group(9% ) ( P ＜0.05 ).Absolute blood glucose level was found to be significantly higher in group 2 in 10th day (7.4 ± 1.6)mmol/L,which is greater than that in 1 group ( 5.1 ± 0.8 ) mmol/L and 3 group ( 5.6 ± 1.2 ) mmol/L ( P ＜ 0.05 ).Dysphoria and deliration appear in one patient in group 2.Conclusions Nebulised budesonide,an effective and safe alternative to systemic corticosteroids in treatment of exacerbated COPD,may substitute systemic corticosteroids in clinical practice.