Abstract
BACKGROUND: Guidelines specify steroids as therapy for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the duration of survival benefit associated with steroids and the optimal dosage of nebulized budesonide (NB) during hospitalization remain unclear. METHODS: We conducted a retrospective study of hospitalized AECOPD patients. The primary endpoint was all-cause mortality after discharge. Cox regression analysis was used to determine the impact of steroid therapy on survival. RESULTS: Wilcoxon analysis showed the positive impact of systemic corticosteroids (SCs) therapy on survival during the early stage of follow-up (P = 0.038). NB therapy was associated with a significantly reduced risk of death within six months after discharge (adjusted Hazard ratio (HR), 0.36; 95% confidence interval (CI) 0.15-0.88). Subgroup analysis suggested that fewer than two AEs in the previous year (adjusted HR 0.05; 95% CI 0.01-0.38), age > = 65 years (adjusted HR 0.31; 95% CI 0.11-0.90), body mass index (BMI) < 25 kg/m(2) (adjusted HR 0.33; 95% CI 0.12-0.92), and smoking index > 40 packets/year (adjusted HR 0.17; 95% CI 0.04-0.79) were involved in this association. Finally, treatment with a total dose of NB < = 60 mg during hospitalization reduced six-month mortality compared to treatment without steroids (adjusted HR 0.39; 95% CI 0.17-0.92), but not the total dose of NB > 60 mg. CONCLUSIONS: NB therapy for hospitalized AECOPD patients significantly reduced six-month mortality. Subgroup analysis showed that certain populations benefited more from NB therapy, and < = 60 mg NB might be suitable treatment for hospitalized AECOPD patients.