Clinical Outcomes Of Using Nebulized Budesonide As The Initial Treatment For Acute Exacerbations Of Chronic Obstructive Pulmonary Disease: A Post-Hoc Analysis

Figures & data

Table 1 Demographic Characteristics For NBS Or SCS By Intravenous Injection As Initial Treatment (Grouped By Further Treatment)

	Dose-Escalation Group (NBS Initial)	Dose Maintenance Or Reduction Group (NBS Initial)	Dose Maintenance Or Escalation Group (SCS Initial)	Dose-Reduction Group (SCS Initial)	P-Value
	(N=756)	(N=1443)	(N=404)	(N=518)
	Mean ± SD
Age (years)	72.9±9.3	72.5±9.7	73.2±9.6	73.0±9.3	0.01
BMI (kg/m^2)	22.1±3.5	22.2±3.9	22.0±3.3	21.9±3.4	0.85
COPD history (years)	9.3±8.7	9.1±8.9	10.3±9.7	11.6±10.1	0.61
AECOPD duration (days)	20.8±58.1	17.6±27.9	19.7±37.4	14.5±23.9	0.33
Baseline PaO2 (mmHg)	74.9±27.3	74.8±25.5	78.6±30.9	84.1±36.9	0.02
Baseline PaCO2 (mmHg)	51.3±15.6	48.0±14.3	51.2±18.9	52.7±18.9	<0.001
Baseline SaO2	91.6±8.3	91.8±8.4	91.7±9.1	92.8±8.0	0.06
Baseline pH	7.4±0.1	7.4±0.4	7.4±0.1	7.4±0.1	<0.001
	N (%)
Sex
Male	590 (78.0%)	1047 (72.6%)	308 (76.2%)	407 (78.6%)	0.67
Female	166 (22.0%)	395 (27.4%)	96 (23.8%)	111 (21.4%)
Baseline pH categories
<7.35	130 (17.2%)	224 (15.5%)	78(19.3%)	85 (16.4%)	0.49
7.35–7.45	449 (59.4%)	917 (63.5%)	227 (56.2%)	314 (60.6%)
>7.45	68 (9.0%)	167 (11.6%)	47 (11.6%)	59 (11.4%)
Smoking status
Never	206 (27.2%)	456 (31.6%)	129 (31.9%)	170 (32.8%)	0.38
Current	211 (27.9%)	365 (25.3%)	97 (24.0%)	122 (23.6%)
Ever	327 (43.3%)	616 (42.7%)	172 (42.6%)	218 (42.1%)
Living environment^a
Long-term passive smoking	48 (6.3%)	124 (8.6%)	26 (6.4%)	48 (9.3%)	0.49
Long-term exposure to occupational dust and gas fumes	58 (7.7%)	89 (6.2%)	18 (4.5%)	41 (7.9%)
Air pollution^b	232 (30.7%)	595 (41.2%)	182 (45.0%)	175 (33.8%)
None of the above	402 (53.2%)	628 (43.5%)	182 (45.0%)	207 (40.0%)

Notes: P-value is adjusted by site. ^aEach patient may have multiple factors, which makes the sum larger than 100%. ^bAir pollution is based on the address of the patients and the official air quality index (AQI).

Abbreviations: NBS, nebulized budesonide; SCS, systemic corticosteroid (oral/intravenous); SD, standard deviation.

Table 2 Clinical Outcomes Of NBS Or SCS By Intravenous Injection As Initial Treatment (Grouped By Further Treatment)

	Dose-Escalation Group (NBS Initial)	Dose Maintenance Or Reduction Group (NBS Initial)	Dose Maintenance Or Escalation Group (SCS Initial)	Dose-Reduction Group (SCS Initial)	P-Value
	(N=756)	(N=1443)	(N=404)	(N=518)
	Mean ± SD
Length of hospital stay (days)	13.9±7.8	11.7±5.8	11.3±4.9	13.3±5.4	<0.001
Improvement of FEV1 (%)	−8.4±44.4	12.0±12.2	7.5±14.1	4.7±10.4	<0.001
Improvement of PaO2 (mmHg)	7.5±34.1	5.1±29.3	6.1±40.8	2.3±48.5	0.24
Improvement of PaCO2 (mmHg)	−3.5±15.1	−4.3±13.2	−5.9±16.5	−5.1±17.8	0.53
Improvement of SaO2	3.5±9.0	3.5±10.8	3.7±13.2	2.9±10.2	0.43
Improvement of pH	0.0±0.1	0.0±0.1	0.0±0.1	0.0±0.1	0.74
Hospitalization expenses	19,004.3±18,522.9	13,582.7±11,680.1	15,154.0±10,625.2	15,856.7±12,616.3	<0.0001
	N (%)
Intubation rate	25 (3.3%)	26 (1.8%)	13 (3.2%)	13 (2.5%)	<0.001
Mortality	14 (1.9%)	10 (0.7%)	11 (2.7%)	6 (1.2%)	<0.001
Rate of new-onset pneumonia	25 (3.3%)	17 (1.2%)	11 (2.7%)	15 (2.9%)	0.30

Notes: P-value is adjusted by site. The expenses represent all treatment costs during the entire treatment period, including (but not limited to) medications, equipment, bed costs, and care costs. Currency value is RMB.

Abbreviation: SD, standard deviation.

Table 3 Clinical Outcomes Of NBS Or SCS By Intravenous Injection As Initial Treatment (Grouped By Further Treatment), Stratified By PaCO₂

		Dose-Escalation Group (NBS Initial)	Dose Maintenance Or Reduction Group (NBS Initial)	Dose Maintenance Or Escalation Group (SCS Initial)	Dose-Reduction Group (SCS Initial)	P-Value
		(N=756)	(N=1443)	(N=404)	(N=518)
PaCO2 ≤ 50 (mmHg)	Intubation rate	7 (0.9%)	10 (0.7%)	2 (0.5%)	3 (0.6%)	0.37
	Mortality	7 (0.9%)	6 (0.4%)	5 (1.2%)	2 (0.4%)	<0.001
	Rate of new-onset pneumonia	13 (1.7%)	10 (0.7%)	8 (2.0%)	10 (1.9%)	0.19
PaCO2 > 50 (mmHg)	Intubation rate	17 (2.2%)	16 (1.1%)	11 (2.7%)	10 (1.9%)	0.001
	Mortality	7 (0.9%)	3 (0.2%)	6 (1.5%)	4 (0.8%)	0.005
	Rate of new-onset pneumonia	10 (1.3%)	5 (0.3%)	3 (0.7%)	5 (1.0%)	0.81

Note: P-value is adjusted by site.