title: A step-wise application of methylprednisolone versus dexamethasone in the treatment of acute exacerbations of COPD.
abstract: OBJECTIVE
  The aim of the study was to explore the clinical value of a step-wise application of methylprednisolone (MP) compared to dexamethasone (DXM) in acute exacerbations of COPD.
  
  
  METHODS
  One hundred and forty-two patients with an acute exacerbation of COPD were divided randomly into two groups: 71 patients were treated with MP and the other 71 patients were treated with DXM. Otherwise each group was given the same basic treatments: antibiotics, bronchodilators, oxygen therapy as well as standard hospital care. The patients in the MP group were given a tapering dose of MP for 7-14 days, and the patients in the DXM group were given a corresponding tapering dose of DXM for 7-14 days. Then both groups were given a gradually reducing dose of oral prednisone for 2-3 weeks. Two weeks before the prednisone was tapered off, inhaled corticosteroid was introduced. The patients' symptom scores, physical signs, per cent predicted FEV1%, and arterial blood gases were monitored before treatment and after the seventh day of treatment.
  
  
  RESULTS
  There was an obvious improvement in symptoms after 1-3 days in all 71 patients in the MP group, with their wheezing being distinctly reduced or disappearing entirely. The maximum benefit that occurred in the MP group (90.14%) was considerably higher than that of the DXM group (25.35%), P < 0.05. The predicted FEV1% in the MP group increased from 46.7 +/- 10.6 to 67.5 +/- 12.4, compared with an increase in the DXM group from 50.1 +/- 7.6 to 58.9 +/- 10.8. The difference between the two groups was significant (P < 0.05).
  
  
  CONCLUSIONS
  An adequate and tapering dose of MP used in acute exacerbations of COPD can relieve the inflammatory reaction in airways and reduce airway spasm more promptly than DXM.
authors.affiliation: Shanghai Pulmonary Hospital, Shanghai, PR China. wlwq@sh163.net
authors.forename: Huiping
authors.initials: H
authors.lastname: Li
authors.forename: Guojun
authors.initials: G
authors.lastname: He
authors.forename: Haiqing
authors.initials: H
authors.lastname: Chu
authors.forename: Lan
authors.initials: L
authors.lastname: Zhao
authors.forename: Hui
authors.initials: H
authors.lastname: Yu
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D012129:Respiratory Function Tests; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D008775:Methylprednisolone