Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Mar 16:15:567-574.
doi: 10.2147/COPD.S236305. eCollection 2020.

Do Benefits Outweigh Risks for Corticosteroid Therapy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in People with Diabetes Mellitus?

Ali M Aldibbiat  1   2 , Ahmed Al-Sharefi  3
Affiliations
Review

Do Benefits Outweigh Risks for Corticosteroid Therapy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in People with Diabetes Mellitus?

Ali M Aldibbiat et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are chronic health conditions with significant impacts on quality and extent of life. People with COPD and DM appear to have worse outcomes in each of the comorbid conditions. Treatment with corticosteroids in acute exacerbation of COPD (AECOPD) has been shown to reduce treatment failure and exacerbation relapse, and to shorten length of hospital stay, but not to affect the inexorable gradual worsening of lung function. Treatment with corticosteroids can lead to a wide spectrum of side effects and complications, including worsening hyperglycemia and deterioration of diabetes control in those with pre-existing DM. The relationship between COPD and DM is rather complex and accumulating evidence indicates a distinct phenotype of the comorbid state. Several randomized controlled trials on corticosteroid treatment in AECOPD excluded people with DM or did not report on outcomes in this subgroup. As such, the perceived benefits of corticosteroids in AECOPD in people with DM have not been validated. In people with COPD and DM, the detrimental side effects of corticosteroids are guaranteed, while the benefits are not confirmed and only presumed based on extrapolation from the general COPD population. Therefore, the potential for harm when prescribing corticosteroids for AECOPD in people with DM cannot be excluded.

Keywords: COPD; acute exacerbation of COPD; corticosteroids; diabetes mellitus; hyperglycemia; metabolic syndrome.

PubMed Disclaimer

Conflict of interest statement

Both authors declare no relevant conflicts of interest for this work.

Figures

Figure 1
Figure 1
Venn diagram demonstrating overlap between COPD (orange circle, 251 million1), DM (blue circle, 425 million10), and metabolic syndrome (yellow circle, 1275 million11). The prevalence of DM and COPD is estimated at 43 million– (area A+C), metabolic syndrome and COPD at 85 million (area B+C), and COPD with DM and/or metabolic syndrome (area A+B+C) at 107 million.
Figure 2
Figure 2
The self-perpetuating cycle of AECOPD treated with corticosteroids which leads to hyperglycemia, which in turn increases airway predisposition to infections.
Figure 3
Figure 3
Factors through which poorly controlled diabetes mellitus contributes to increased susceptibility for AECOPD and deterioration of COPD.
See this image and copyright information in PMC

References

    1. World Health Organisation. COPD factsheet. Fact Sheets; 2017. Available from: http://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulm...). Accessed January7, 2019.
    1. Cavaillès A, Brinchault-rabin G, Dixmier A, et al. Comorbidities of COPD. Eur Respir Rev. 2013;22:454–475. doi:10.1183/09059180.00008612 - DOI - PMC - PubMed
    1. Chatila WM, Thomashow BM, Minai OA, Criner GJ, Make BJ. Comorbidities in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5(4):549–555. doi:10.1513/pats.200709-148ET - DOI - PMC - PubMed
    1. McAuley SA, Horsburgh JC, Ward GM, et al. Insulin pump basal adjustment for exercise in type 1 diabetes: a randomised crossover study. Diabetologia. 2016;59:1636–1644. doi:10.1007/s00125-016-3981-9 - DOI - PubMed
    1. Vanfleteren LEGW. Does COPD stand for “COmorbidity with Pulmonary Disease”? Eur Respir J. 2015;45(1):14LP- 17. doi:10.1183/09031936.00148014 - DOI - PubMed

MeSH terms

Substances