Expert panel consensus recommendations on the utilization of nebulized budesonide for managing asthma and COPD in both stable and exacerbation stages in Thailand.

OBJECTIVE: This study investigated the utilization of nebulized budesonide for acute asthma and COPD exacerbations as well as for maintenance therapy in adults. DATA SOURCES: We conducted a search on PubMed for nebulized budesonide treatment. SELECTED STUDIES: Selecting all English-language papers that utilize Mesh phrases "asthma," "COPD," "budesonide," "nebulized," "adult," "exacerbation," and "maintenance" without temporal restrictions, and narrowing down to clinical research such as RCTs, observational studies, and real-world studies. RESULTS: Analysis of 25 studies was conducted to assess the effectiveness of nebulized budesonide in asthma (n = 10) and COPD (n = 15). The panel in Thailand recommended incorporating nebulized budesonide as an additional or alternative treatment option to the standard of care and systemic corticosteroids (SCS) based on the findings. CONCLUSION: Nebulized budesonide is effective and well-tolerated in treating asthma and COPD, with less systemic adverse effects compared to systemic corticosteroids. High-dose nebulized budesonide can enhance clinical outcomes for severe and mild exacerbations with slow systemic corticosteroid response. Nebulized budesonide can substitute systemic corticosteroids in some situations.

Procalcitonin under Investigation as a Means of Detecting Severe Sepsis, Septic Shock and Bacteremia at Emergency Department, Rajavithi Hospital.

BACKGROUND: Severe sepsis, septic shock and bacteremia are critical illnesses, and patients with these conditions require close monitoring and immediate medical treatment. Any delay in diagnosis may lead to an increase in mortality in such critically ill patients. Serum procalcitonin (PCT) has emerged as a highly accurate biomarker for differentiating sepsis from other non-infectious triggers. OBJECTIVE: In this study, we investigated the effectiveness of PCT in obtaining early diagnosis and efficient prognosis for such patients at the Emergency Department of Rajavithi Hospital. MATERIAL AND METHOD: A prospective study was performed of 110 adult patients who attended the emergency service department between August 1 2013 and October 31 2013. The effectiveness of PCT as a specific blood test analysis tool for detecting and classifying the severity of patients with sepsis was investigated, and sensitivity, specificity, negative predictive values (NPV), positive predictive values (PPV) and positive likelihood ratio (LR+) were used to differentiate infected patients. RESULTS: One hundred and ten patients were enrolled and classified into 3 categories as follows: severe sepsis (n = 34, 30.9%), septic shock (n = 13, 11.8%), and bacteremia (n = 23, 20.9%). At a PCT level of ≥ 2 ng/dL, it was feasible to categorize patients as having severe sepsis (p < 0.001; RR 3.58; 95% CI 2.18-5.89), septic shock (p = 0.001; 5.73; 2.06- 15.93) or bacteremia (p < 0.001; 3.91; 1.98-7.73). Moreover, the PCT value yielded the following diagnostic performances for patients with: severe sepsis (PPV 70.8%; NPV 80.2%; LR+ 5.0; sensitivity 50.0%; specificity 90.8%); septic shock (33.3%; 94.2%; 3.6; 61.5%; 83.5%); and bacteremia (50.0%; 87.2%; 3.7; 52.2%; 86.2%). CONCLUSION: PCT can be usefully employed as a promising chemical biomarker to differentiate the severity of infections in critically ill patients. Used together with clinical data, the PCT value of ≥ 2 ng/dL is efficient in categorizing such patients as having severe sepsis, septic shock or bacteremia.

Factors Associated with Hospitalization of Chronic Obstructive Pulmonary Disease Patients with Acute Exacerbation in the Emergency Department, Rajavithi Hospital.

BACKGROUND: Chronic Obstructive Pulmonary Disease with acute exacerbation (AECOPD) is a condition, which frequently results in patients visiting the emergency department (ED). Recently, many studies have reported new factors, which cause AECOPD-patients (AECOPDs) to require urgent hospital admission. OBJECTIVE: To determine the crucial factors of AECOPDs that are associated with patients who visit the ED being admitted to Rajavithi Hospital. MATERIAL AND METHOD: This retrospective cross-sectional study was performed from May 1, 2011 to June 30, 2013. Seventy patients were included and their medical records were reviewed. A logistic regression model (SPSSv17) was used to analyze the prognostic factors associated with hospitalization. RESULTS: The study found that patients with a respiratory rate >24 breaths per minute (OR = 3.43; 95% CI = 1.10-10.84; p = 0.040), pulse rate >120 beats per minute (OR = 4.10; 95% CI = 1.31-12.74; p = 0.020), and oxygen saturation <90% (OR = 5.25; 95% CI = 1.20-23.00; p = 0.030), were prone to be admitted to the hospital. Furthermore, such patients more often required hospitalization if they had met any of the following criteria: had respiratory-infection related Global Initiative for Chronic Obstructive Lung Disease standard stages 3-4; were receiving home oxygen therapy; had an annual rate of ED visits of more than 2; had higher leukocytes; classified in the ED emergency triage as emergent; or who received antibiotics at the ED. CONCLUSION: Respiratory rate, heart rate and oxygen saturation are the crucial symptoms of AECOPDs to which physicians at ED should pay special attention. Such factors are reasonable indicators for hospitalization in order to reduce ED overcrowding. The study also found that patients treated early with antibiotics in the ED may be associated with subsequent hospitalization for ongoing management. However further studies are required for verification.