Systemic glucocorticoids in severe exacerbations of COPD.
OBJECTIVE
This study aimed to compare the efficacies of 3-day and 10-day courses of methylprednisolone (MP) treatment in severe COPD exacerbations necessitating hospitalization for respiratory failure.


METHODS
Prospective, randomized, single-blind study.


METHODS
Tertiary-care center.


METHODS
Thirty-six patients were included in the study and randomized into two groups: group 1 received MP, 0.5 mg/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 on the tenth day. There was no difference between the groups for age, baseline FEV(1), PaO(2), PaCO(2), and pH levels. One patient in group 1 who developed pneumothorax and one patient in group 2 who had steroid-related psychosis could not complete the study.


RESULTS
Both groups showed significant improvements in PaO(2) and FEV(1) levels, but these were more marked in group 2 (p = 0.012 and p = 0.019, respectively). There was a significant increase in FVC levels in group 2 only (p = 0.003). Group 2 also had a more marked improvement in dyspnea on exertion. There was no difference between the two groups with regards to other parameters, including pH, PaCO(2) levels, and other symptom scores. Six patients in group 1 and five patients in group 2 developed new exacerbations within the following 6 months. Hyperglycemia occurred in two patients in each group.


CONCLUSIONS
In severe COPD exacerbations, a 10-day course of steroid treatment is more effective than a 3-day course in improving the outcome, but has no benefit in reducing exacerbation rates.
Department of Chest Diseases, Ege University Medical School, Izmir, Turkey. asayiner@med.ege.edu.tr
A
A
Sayiner
Z A
ZA
Aytemur
M
M
Cirit
I
I
Unsal
D000208:Acute Disease; D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D012129:Respiratory Function Tests; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D008775:Methylprednisolone