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; Leuppi, Jörg D; Bingisser, Roland; Bodmer, Michael; Briel, Matthias; Drescher, Tilman; Duerring, Ursula; Henzen, Christoph; Leibbrandt, Yolanda; Maier, Sabrina; Miedinger, David; Mueller, Beat; Scherr, Andreas; Schindler, Christian; Stoeckli, Rolf; Viatte, Sebastien; Von Garnier, Christophe; Tamm, Michael; 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. BioScientifica Ltd. 10.1530/EJE-15-0182

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OBJECTIVE To analyze prospectively the hypothalamic-pituitary-adrenal (HPA) axis and clinical outcome in patients treated with prednisone for exacerbated chronic obstructive pulmonary disease (COPD). DESIGN Prospective observational study. SUBJECTS AND METHODS 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. RESULTS 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. CONCLUSION 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Bodmer, Michael and Von Garnier, Christophe

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0804-4643

Publisher:

BioScientifica Ltd.

Language:

English

Submitter:

Jacques Donzé

Date Deposited:

23 Mar 2016 15:51

Last Modified:

25 Mar 2016 15:29

Publisher DOI:

10.1530/EJE-15-0182

PubMed ID:

25855628

BORIS DOI:

10.7892/boris.77311

URI:

https://boris.unibe.ch/id/eprint/77311

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