Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease.
BACKGROUND
In this randomized, double-blind, placebo-controlled trial, we studied the effectiveness of prednisone in reducing the risk of relapse after outpatient exacerbations of chronic obstructive pulmonary disease (COPD).


METHODS
We enrolled 147 patients who were being discharged from the emergency department after an exacerbation of COPD and randomly assigned them to 10 days of treatment with 40 mg of oral prednisone once daily or identical-appearing placebo. All patients received oral antibiotics for 10 days, plus inhaled bronchodilators. The primary end point was relapse, defined as an unscheduled visit to a physician's office or a return to the emergency department because of worsening dyspnea, within 30 days after randomization.


RESULTS
The overall rate of relapse at 30 days was lower in the prednisone group than in the placebo group (27 percent vs. 43 percent, P=0.05), and the time to relapse was prolonged in those taking prednisone (P=0.04). After 10 days of therapy, patients in the prednisone group had greater improvements in forced expiratory volume in one second than did patients in the placebo group (mean [+/-SD] increase from base line, 34+/-42 percent vs. 15+/-31 percent; P=0.007). Patients in the prednisone group also had significant improvements in dyspnea, as measured by the transitional dyspnea index (P=0.04) and by the dyspnea domain of the Chronic Respiratory Disease Index Questionnaire (P=0.02), but not in health-related quality of life (P=0.14).


CONCLUSIONS
Outpatient treatment with oral prednisone offers a small advantage over placebo in treating patients who are discharged from the emergency department with an exacerbation of COPD.
Aaron
Shawn D
SD
Department of Medicine, University of Ottawa, Ottawa, Ont, Canada. saaron@ottawahospital.on.ca
Vandemheen
Katherine L
KL
Hebert
Paul
P
Dales
Robert
R
Stiell
Ian G
IG
Ahuja
Jan
J
Dickinson
Garth
G
Brison
Robert
R
Rowe
Brian H
BH
Dreyer
Jonathan
J
Yetisir
Elizabeth
E
Cass
Daniel
D
Wells
George
G
D000208:Acute Disease; D000284:Administration, Oral; D000368:Aged; D000553:Ambulatory Care; D004311:Double-Blind Method; D004638:Emergency Treatment; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011241:Prednisone / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000517:prevention & control; D011788:Quality of Life; D055502:Secondary Prevention; D016896:Treatment Outcome
D005938:Glucocorticoids; D011241:Prednisone