title: Steroids in acute exacerbations of chronic obstructive pulmonary disease: are nebulized and systemic forms comparable?
abstract: OBJECTIVE
  Systemic corticosteroids are strongly recommended in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD). As COPD patients are usually elderly and are relatively immobile, side effects of systemic corticosteroids frequently outweigh their beneficial effects. On the contrary, nebulized corticosteroid solutions have a negligible systemic side-effect profile. In this review, as an alternative to systemic corticosteroids, the place of nebulized corticosteroids in exacerbation periods of COPD was summarized.
  
  
  RESULTS
  The number of trials in the literature is increasing. Regarding the available data, high dose nebulized budesonide was found as effective as systemic corticosteroids in exacerbations of COPD. The side-effect profile, blood glucose level in particular, is better for nebulized budesonide.
  
  
  CONCLUSIONS
  Findings from recent studies are giving a positive impression on the role of high dose nebulized budesonide in exacerbations of COPD. However, larger and statistically high powered trials testing different types of nebulized corticosteroid solutions with varying dosages are still lacking. Before recommending the routine use of nebulized corticosteroids in exacerbations, present findings need to be confirmed with further studies of high quality.
authors.affiliation: Turgut Ozal Research Center, Department of Pulmonary and Sleep Medicine, Inonu University, Malatya 44069, Turkey. hgunen@yahoo.com
authors.forename: Hakan
authors.initials: H
authors.lastname: Gunen
authors.forename: Arzu
authors.initials: A
authors.lastname: Mirici
authors.forename: Mehmet
authors.initials: M
authors.lastname: Meral
authors.forename: Metin
authors.initials: M
authors.lastname: Akgün
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D001786:Blood Glucose / Q000378:metabolism; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001786:Blood Glucose; D019819:Budesonide