Assessment of glycemic status of COPD patients on long term corticosteroid therapy
DOI:
https://doi.org/10.18203/2320-6012.ijrms20173970Keywords:
COPD, Glycemic status, Inhaled corticosteroid, Systemic corticosteroidAbstract
Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Among the pharmacological therapy, inhaled beta- agonist and anticholinergics are the mainstay therapy of COPD along with corticosteroid. Steroid therapy is associated with various potential adverse effects like steroid induced deranged glycemic status. So, we sought to examine the association between long term corticosteroid therapy and glycemic status in COPD patients.
Methods: A cross sectional study was done to assess the glycemic status in COPD patients on long term corticosteroid therapy in a rural tertiary care centre on patients satisfying inclusion and exclusion criteria. Inclusion criteria includes COPD patients on steroid based therapy (inhaled/systemic or both) for at least 6 months. Known case of type 2 diabetes mellitus, bronchial asthma, interstitial lung disease, coronary artery disease, cardiomyopathies, connective tissue disorders, recipients of organ transplant or immunosuppressive therapy, patients having co morbidities like renal failure, liver failure, heart failure and patients on other drugs known to cause hyperglycemia were excluded. Random blood sugar, HbA1C etc, was done and data was analyzed by SPSS version 22.0.
Results: Total 46 patients were included in study. Mean age was 63.22 years with minimum age 47 years and maximum age 80 years. 35 patients (76.09%) were male and 11 patients (23.91%) were female. Sex ratio was 3.18:1. 26 patients (56.52%) were taking both inhaled and systemic corticosteroids, 12 patients (26.09%) were taking only inhaled corticosteroids and 8 patients (17.39%) were taking systemic corticosteroid therapy. 14 patients (30.43%) were found to have impaired glucose tolerance, 7 patients (15.22%) were diagnosed as a case of diabetes mellitus and 25 patients (54.35%) were found to be euglycemic.
Conclusions: We conclude that incidence of deranged glycemic status is more common among COPD patients receiving only systemic corticosteroid therapy or both systemic and inhaled corticosteroid therapy. Further, inhaled corticosteroids are better in terms of glycemic control among COPD patients on corticosteroid therapy. Hence, we recommend routine screening of glycemic status in COPD patients on corticosteroid therapy.
References
Barnes PJ. Chronic obstructive pulmonary disease. N Engl J Med. 2000;343(4):269-80.
Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS. GOLD scientific committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI/ WHO global initiative for chronic obstructive lung disease (GOLD) workshop summary. Am J Respir Crit Care Med. 2001;163(5):1256-76.
Sin DD, McAlister FA, Man SFP, Anthonisen NR. Contemporary management of chronic obstructive pulmonary disease: scientific review. JAMA. 2003;290(17):2301-12.
McCrory DC, Brown C, Gelfand SE, Bach PB. Management of acute exacerbations of COPD: a summary and appraisal of published evidence. Chest. 2001;119(4):1190-209.
Jindal SK, Aggarwal AN, Chaudhry K, Chhabra SK, D Souza GA, Gupta D, et al. A multicentric study on epidemiology of chronic obstructive pulmonary disease and its relationship with tobacco smoking and environmental tobacco smoke exposure. Indian J Chest Dis Allied Sci. 2006;48:23-9.
Jindal SK, Aggarwal AN, Gupta D, Agarwal R, Kumar R, Kaur T, et al. Indian study on epidemiology of asthma, respiratory symptoms and chronic bronchitis in adults (INSEARCH). Int J Tuberc Lung Dis. 2012;16:1270-7.
Global initiative for chronic obstructive lung disease (GOLD) (2014). Global strategy for diagnosis, management and prevention of COPD. (online) Available at www.goldcopd.org/uploads/users/files/GOLD_Report_2014_.
American Thoracic Society. Available at www.thoracic.org. Accessed Dec 22, 2005.
Corticosteroids in chronic obstructive pulmonary disease: clinical benefits and risks. Clin Chest Med. 2000;21(4):739-52.
Miravitlles M, Mayordomo C, Artes M, Sanchez-Agudo L, Nicolau F, Segu JL. Treatment of chronic obstructive pulmonary disease and its exacerbations in general practice. EOLO Group. Observational study of obstructive limitation to air flow. Respir Med. 1999;93(3):173-9.
Jackevicius C, Joyce DP, Kesten S, Chapman KR. Prehospitalization inhaled corticosteroid uses in patients with COPD or asthma. Chest. 1997;111(2):296-302.
Donohue JF, Van Noord JA, Bateman ED, Langley SJ, Lee A, Witek TJ, et al. A 6-month, placebo-controlled study comparing lung function and health status changes in COPD patients treated with tiotropium or salmeterol. Chest. 2002;122(1):47-55.
McEvoy CE, Niewoehner DE. Corticosteroids in chronic obstructive pulmonary disease. Clinical benefits and risks. Clin Chest Med. 2000;21:739-52.
Spencer S, Calverley PM, Sherwood Burge P, Jones PW. ISOLDE study group. Inhaled steroids in obstructive lung disease: health status deterioration in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:122-8.
Calverley PM, Anderson JA, Celli B, Ferguson GT, Jenkins C, Jones PW, Yates JC, et al. TORCH investigators. Salmeterol and Fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775-89.
Bernes PJ. Inhaled corticosteroids in COPD: a controversy. Respiration. 2010;80:89-95.
Schlaghecke R, Kornely E, Santen R, Ridderskamp P. The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N Engl J Med. 1992;326(4):226-30.
Seeman E, Wahner HW, Offord KP, Kumar R, Johnson WJ, Riggs BL. Differential effects of endocrine dysfunction on the axial and appendicular skeleton. J Clin Invest. 1982;69(6):1302-9.
Messer J, Reitman D, Sacks HS, Smith H Jr, Chalmers TC. Association of adrenocortico-steroid therapy and peptic-ulcer disease. N Engl J Med. 1983;309(1):21-4.
Acute adverse reactions to prednisone in relation to dosage. Clin Pharmacol Ther. 1972;13(5):694-8.
Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking Glucocorticosteroid. Rev Infect Dis. 1989;11(6):954-63.
Sulica L. Laryngeal thrush. Ann Otol Rhinol Laryngol. 2005;114(5):369-75.
Daniell HW. Osteoporosis of the slender smoker: vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Intern Med. 1976;136(3):298-304.
Seeman E, Melton LJ III, O’Fallon WM, Riggs BL. Risk factors for spinal osteoporosis in men. Am J Med. 1983;75(6):977-83.
Smyllie HC, Connolly CK. Incidence of serious complications of corticosteroid therapy in respiratory disease. A retrospective survey of patients in the Brompton hospital. Thorax. 1968;23(6):571-81.
Niewoehner DE, Erbland ML, Deupree RH, Collins D, Gross NJ, Light RW, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of veteran’s affairs cooperative study group. N Engl J Med. 1999;340(25):1941-7.
Slatore CG, Bryson CL, Au DH. The association of inhaled corticosteroid use with serum glucose concentration in a large cohort. Am J Med. 2009;122:472e-8.
Faul JL, Wilson SR, Chu JW, Canfield J, Kuschner WG. The effect of an inhaled corticosteroid on glucose control in type 2 diabetes. Clin Med Res. 2009;7:14e-20.
Suissa S, Kezouh A, Ernst P. Inhaled corticosteroids and the risks of diabetes onset and progression. Am J Med. 2010;123:1001e-6.
Gartlehner G, Hansen RA, Carson SS, Lohr KN. Efficacy and safety of inhaled corticosteroids in patients with COPD: a systematic review and meta-analysis of health outcomes. Ann Fam Med. 2006;4:253-62.
Faul JL, Tormey W, Tormey V, Burke C. High dose inhaled corticosteroids and dose dependent loss of diabetic control. BMJ. 1998;317:1491.
Faul JL, Cormican LJ, Tormey VJ, Tormey WP, Burke CM. Deteriorating diabetic control associated with high-dose inhaled budesonide. Eur Respir J. 1999;14:242-3.
Lung health study research group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Engl J Med. 2000;343:1902-9.
Dendukuri N, Blais L, LeLorier J. Inhaled corticosteroids and the risk of diabetes among the elderly. Br J Clin Pharmacol. 2002;54:59-64.
Blackburn D, Hux J, Mamdani M. Quantification of the risk of corticosteroid- induced diabetes mellitus among the elderly. J Gen Intern Med. 2002;17:717-20.
