Tight Glycemic Control in Acute Exacerbations of COPD

Glucose control has been shown as an important and independent prognostic factor in several acute conditions in hospitalized patients, including Acute MI, stroke, cardiac surgery and in critical care units. Patients with acute exacerbation of COPD (AECOPD)and diabetes treated with insulin had a longer in-patient stay and more frequent isolation of Gram negative bacteria from sputum than those without diabetes.Hyperglycemia (>11 mmol/l) on admission predicted failure of non-invasive ventilation and infectious pulmonary complications in patients admitted to the ICU with acute respiratory failure caused by severe AECOPD. The primary goal of this study is to test the hypothesis that in AECOPD, tight glycemic control during hospital stay will improve outcome of hospitalization. The secondary goal of this study is to test new ways in controlling patients in the internal medicine ward.

Inclusion Criteria: current or past smokers (at least 20 py) patient with COPD be ATS criteria hospitalized with acute exacerbation, 2/3 criteria:1- worsening of SOB 2-change in sputum volume 3- change in sputum color signed informed concent Exclusion Criteria: respiratory failure (pH<7.35 ו Pco2>60 ) pneumonia pneumothorax bronchiectasis lung collapse congestive heart failure lung cancer suspected pulmonary emboli immune deficiency (acquired 0r congenital) cystic fibrosis post lung implantation asthma/ non smokers