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ORTA VE AĞIR KOAH'TA SİSTEMİK KORTİKOSTEROİDLERİN YERİ

Role of Systemic Corticosteroids In Moderate And Severe COPD

Journal Name:

  • İnönü Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2000

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Ro'e of systemic corticosteroids (CS) in treatment of chronic obstructive pu'monary diseases (COPD) is quite controversial Considering side effects of systemic CS, their efficacy shou'd be c'ear'y documented with objective criteria before their chronic utilization. In our study, 25 grade II (n=20, FEV1 between 49 and 35%) and grade III (n=5, FEV1<35%) stab'e COPD patients were prescribed 48 mg methy' predniso'on as a sing'e dai'y morning dose for 15 days in addition to their c'assic COPD treatment. When with their initia' and 15th day forced expiratory vo'ume (FEV1) va'ues, four patients (16%) demonstrated an improvement exceeding 15%. Protecting their improvement, their systemic CS doses were tapered s'ow'y; meanwhile systemic CS doses in other patients, who did not show sufficient improvement, were rapid'y tapered and stopped. After estab'ishing minima' systemic CS doses, regarding FEV1 improvement, study was terminated. When compared with initia' FEV1 'eve's, average FEV1 improvement was 35.1% in four patients who benefited systemic CS, and 2.2% in the other 21 patients who did not (p<0.05). In conc'usion, we think that systemic CS shou'd be utilized as a 'ast stage treatment option in grade II and III patients without any contraindication, who cou'd not be treated sufficient'y and are symptomatic with maximum c'assic COPD treatment.
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Abstract (Original Language): 
Kronik obstrüktif akciğer hastalıklarının (KOAH) tedavisinde sistemik kortikosteroidlerin (KS) yeri oldukça tartışmalıdır. Sistemik KS'lerin yan etkilerinden dolayı kronik kullanımlarında kesin fayda'ı o'duklarının objektif kriter'er'e be'ir'enmesi esastır. Ça'ışmamızda top'am 25, evre II (n=20, FEV1:%49 i'e %35arasında) ve evre III(n=5, FEV1<%35) stabıl KOAH'ı hastanın k'asik tedavilerine 15 gün süre i'e her gün sabah'arı tek doz a'ınmak üzere 48mg metil prednı'zo'on eklendi. Hasta'arın baş'angıç ve 15. gün lorse ekspiratuar vo'um (FEV1) 'eri karşı'aştırı'dığında 4 hastanın (%16) FEV11nde %151n üzerinde düze'me göz'endi Bu hasta'arın sistemik KS doz'arı yavaş yavaş aza'tı'arak devam edilirken, 15 gün'ük KS denemesinden fayda görmeyen 21 hastanın steroidi hız'a aza'tı'arak kesi'di. Sistemik KS'den fayda gören hasta'arda FEV1 artışının korunduğu en düşük metılprednizo'on doz'arı bu'unduktan sonra ça'ışma son'andırı'dı. Sistemik KS'den fayda gören 4 hastadaki orta'ama FEV1 artışı %35.1 o'urken, diğer hasta'arda bu oran orta'ama %2.2 o'arak ka'dı (p< 0.05). Sistemik KS'terin maksimum k'asik tedavi i'e be'Oi bir oranın üzerinde düze'ti'emeyen ve semptomatik o'an kontraendikasyonsuz evre II ve III KOAH hasta'arında son basamak tedavi o'arak ku'Oanı'ması gerektiğini düşünüyoruz.
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  • 3
202-206
  • Turkish

REFERENCES

References: 

1.Ortaköylü G, Tuncay E, Karalar S, ve ark. KOAH'ta reversibilite vesteroid kullanımı. Toraks Derneği I.Yıllık Kongresi özet kitapçığı 1996;S28.

2. Postma DS, Steenhuis EJ, van der Weele LT, Sluiter HJ. Severe chronic airflow obstruction: can corticosteroids slow down progression? Eur Respir J Dis 1985; 67:56-64.
3. Jantz MA, Sahn SA. Corticosteroids in acute respiratory failure. Am J Respir CritCare Med 1999; 160:1079-100.
O'Byrne PM, Postma DS. The many faces of airway inflamation: Asthma and chronic airway inflamation. Am J Respir Crit Care Med 1999; 159:Supp.
5. Postma DS, Peters I, Steenhuis EJ, Sluiter HJ. Moderately severe chronic airflow obstruction: can corticosteroids slow down progression. Eur Respir J 1988; 1:22-6.
6. Murray JF, Petty LT. Frontline treatment of COPD. New Jersey: Snowdrift Pulmonary Foundation, Inc., 1996;32-3.
7. American Thoracic Society Statement. Standards for the diagnosisand care of patients with COPD. Am J Respir Crit Care Med 1995; 152;Supp. George RB, San Pedro GS. COPD: Clinical course and management. In: Fishman AP, Elias JA, Fishman JA, eds. Fishman's pulmonary diseases and disorders. New York: McGraw-Hill, 1998;683-96.
9. Ziment I. Pharmacologic theraphy of obstructive airway disease. Clin
Chest Med 1990; 11:461-86.
10. Kerstjens HA, Brand PL, Hughes MD, et al. A comparison of bronchadilator theraphy with or without inhaled corticosteroid theraphy for obstructive airway disease. N Eng J Med 1992; 327:1413-9.
11. Renkema TE, Schouten JP, Koeter GH, et al. Effects of long-term treatment with corticosteroids in COPD. Chest 1996; 109:1156-62.
12. Derenne JP. Effects of high-dose inhaled beclamethesone on the rate of decline in FEV1 in patients with COPD. Am J Respir Crit Care Med 1995; 151:A463.
13. van Grunsven PM, van Schayck CP, Derenne JP, et al. Meta-analysis of the long-term effects of the inhaled corticosteroids in COPD. Eur Respir
J 1997; 10:392S.
8.
14. Paggiaro PL, Dahle R, Bakran I, et al. Multicentre randomized placebo-controlled trial of fluticasone propionate in COPD. Lancet 1998; 351:773-80.
15. Burge PS. A double blind randomized placebo controlled two year study of inhaled beclomethasone dipropionate in patients with COPD. Eur Respir J 1997; 10:391S.
16.
Sipahioğl
u B, Yılmaz G, Erk M. Kronik obstrüktif akciğer hastalığında inhalasyon kortikosteroidlerinin yeri. Türkiye Solunum Araştırmaları Derneği XXI. Kongresi özet kitapçığı 1993:S38.
17. Mirici A, Bektaş Y, Kaynar H, ve ark. KOAH'ta inhaler steroid kullanımının solunum fonksiyonları ve balgam nötrofilisine etkisi. Toraks Derneği 2. Kongresi özet kitapçığı 1998:S84.
18. Calverly PMA. Inhaled corticosteroids are beneficial in COPD. Am J Respir Crit Care Med 2000; 161:341-4.
19. Snider GL, Faling LJ, Rennard SI. Chronic bronchitis and emphysema. In: Murray JF, Nadel JA, eds. Textbook of respiratory medicine vol 2.
Philadelphia: W.B. Saunders, 1994;1331-97.
20. Lebowitz MD, Postma DS, Burrows B. Adverse effects of eosinophilia and smoking on the natural history of newly diagnosed chronic bronchitis. Chest 1995; 108:55-61.
21. Shim C, Stover DE, Williams MH. Response to corticosteroids in chronic bronchitis. J Allergy Clin İmmunol 1978; 62:3637.
22. Harding SM, Freedman S. A comparison of oral and inhaled steroids ni patients with COPD. Thorax 1978; 33:214-7.
23. Weir DC, Gove RI, Robertson AS, et al. Response to corticosteroids in COPD. Eur Respir J 1991; 4:1185-90.
24. Siafakas NM, Vermiere P, Pride NB et al. Optimal assessment and management of COPD. Eur Respir J 1995; 8:1398-1420.
25. Chapman KR. Therapeutic approaches to COPD: An emerging consensus. Am J Med 1996; 100:5-10S.
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