CHEST
Volume 119, Issue 3, March 2001, Pages 726-730
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Clinical Investigations
Systemic Glucocorticoids in Severe Exacerbations of COPD

https://doi.org/10.1378/chest.119.3.726Get rights and content

Objective:

This study aimed to compare the efficaciesof 3-day and 10-day courses of methylprednisolone (MP) treatment insevere COPD exacerbations necessitating hospitalization for respiratoryfailure.

Design:

Prospective, randomized, single-blindstudy.

Settings:

Tertiary-care center.

Patients and methods:

Thirty-six patients were included in the study and randomized into two groups: group 1 received MP, 0.5mg/kg q6h for 3 days, and group 2 was administered the same dosage of MP for the first 3 days, after which it was tapered and terminated onthe tenth day. There was no difference between the groups for age, baseline FEV1, Pao2,Paco2, and pH levels. One patient in group 1who developed pneumothorax and one patient in group 2 who hadsteroid-related psychosis could not complete the study.

Results:

Both groups showed significant improvements inPao2 and FEV1 levels, but thesewere more marked in group 2 (p = 0.012 and p = 0.019,respectively). There was a significant increase in FVC levels in group2 only (p = 0.003). Group 2 also had a more marked improvement indyspnea on exertion. There was no difference between the two groupswith regards to other parameters, including pH, Paco2 levels, and other symptom scores. Sixpatients in group 1 and five patients in group 2 developed newexacerbations with in the following 6 months. Hyperglycemia occurred intwo patients in each group.

Conclusion:

In severe COPDexacerbations, a 10-day course of steroid treatment is more effectivethan a 3-day course in improving the outcome, but has no benefit inreducing exacerbation rates.

Section snippets

Study Population

The study was conducted at a single, tertiary-care center. Thirty-six COPD patients, all current or ex-smokers with a smokinghistory ≥ 20 pack-years and severe airway obstruction(FEV1 < 35% predicted), and who presented with an exacerbation necessitating hospitalization, were included in thestudy. The criteria for admission to the hospital were the presence of severe dyspnea preventing the patient from performing even minoractivities (getting dressed or eating) and resulting in

Results

A total of 198 potential patients who were hospitalized in thechest department of a tertiary-care center were screened for the study. Of these, 36 patients were found to be eligible, were included in thestudy, and were randomized into the two groups. The main reasons forexclusion were prior use of steroids (n = 45), patients'unwillingness to participate (n = 42), presence of decompensated leftheart failure and/or uncontrolled hypertension (n = 37), need formechanical ventilation (n = 29), and

Discussion

This study was designed as a randomized, parallel-group, single-blind study comparing the effects of 3 days and 10 days of treatment with systemic corticosteroids in severe exacerbations of COPD. It did not include a control group with out any steroid treatment, as five controlled studies had already showed that these drugs weresuperior to placebo treatment, resulting in fewer treatment failures, shorter hospital stays, and faster improvement inFEV1 levels.12345 Each of these fivestudies used

ACKNOWLEDGMENT

We thank Hatice Ustün and Timur Kösefor their help with the statistical analyses.

References (12)

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