Chest
Original Research: COPDAntibiotic Treatment of Exacerbations of COPD: A Randomized, Controlled Trial Comparing Procalcitonin-Guidance With Standard Therapy
Section snippets
Patients
From November 2003 to March 2005, consecutive patients ≥ 40 years of age who had been admitted to the emergency department of the University Hospital Basel (Basel, Switzerland) with an ECOPD and met post-bronchodilator therapy spirometric criteria, according to the Global Initiative for Chronic Obstructive Lung Disease guidelines,34within 48 h of emergency department admission were included in this study. An ECOPD was defined as “a sustained worsening of the patient's condition, from the stable
Study Population
From November 2003 to March 2005, 288 patients with suspected COPD exacerbations were admitted to the emergency department (Fig 1). Of the 226 randomly assigned patients, 18 were removed because they failed to meet spirometric criteria for the presence of COPD. No patient dropped out thereafter, and no patient was lost to follow-up.
Baseline characteristics of the patients in both groups were much the same (Table 1). Current use of antibiotic therapy for exacerbations of COPD was reported by 45
Discussion
Our findings indicate that guidance with the measurement of procalcitonin levels reduces the exposure of patients to antibiotics after presentation to the emergency department for exacerbations of COPD. This initial difference in antibiotic exposure is not followed by increased antimicrobial usage after hospitalization for up to 6 months. Thereby, the clinical outcome, including exacerbation rate and time to the next exacerbation, was not compromised. The absolute risk reduction of 31.5% in
Acknowledgments
We are indebted to the patients who participated in this study; to the family physicians for providing follow-up information; to Anja Meyer, Sabina Iannucci, Astrid Vögelin, and Lydia Meier for their most helpful assistance in data collection; to the lung function laboratory staff (Margherita Leo, Germaine Lüdin, Gordana Novicic, Jessica Gebhard, and Diana Wissler); to Fausta Chiaverio for overseeing the laboratory assays; and to Andy Schötzau for statistical advice.
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Cited by (0)
This study was funded by the Clinic of Pulmonary Medicine; the Clinic of Endocrinology, Diabetes and Clinical Nutrition; and the Emergency Department of the University Hospital Basel. BRAHMS provided procalcitonin assays for this investigator-driven study. Dr. Beat Müller has served as consultant and received payments from BRAHMS (the manufacturer of procalcitonin assays) to attend meetings and for travel expenses, speaking engagements, or research. The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.