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Am Fam Physician. 1999;60(8):2415

Low-dose oral corticosteroids are often used in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD). Studies of their usefulness in COPD patients who require hospital admission or emergency department treatment provide conflicting results, with some studies reporting improvement and others reporting no effect. Because corticosteroids can produce significant side effects, a benefit must be clearly demonstrated. Davies and colleagues conducted a prospective, randomized, double-blind, placebo-controlled trial of oral corticosteroids in patients admitted to the hospital because of an acute exacerbation of COPD.

Patients in the study ranged in age from 40 to 80 years (mean age: 67 years) and had severe COPD, by clinical and laboratory assessment. Exclusion criteria included asthma, pneumonia, cardiac failure and use of oral corticosteroids within one month of hospital admission. After comprehensive clinical and laboratory assessment, patients received standard therapy with a beta agonist, an anti-cholinergic agent, oxygen and an antibiotic if indicated. Patients were randomly assigned to receive either 30 mg of prednisolone for 14 days or placebo. Patients maintained symptom diaries during the study. General health questionnaires were completed on the fifth day of admission and at discharge. Patients were reassessed six weeks after admission.

A total of 50 patients (34 men and 16 women) completed the study. The percentage of predicted forced expiratory volume in one second (FEV1) before bronchodilation improved significantly more in the patients who received corticosteroids than in those who did not receive corticosteroids. In the placebo group, FEV1 before bronchodilation rose from 21.4 to 31 percent by the time of discharge. In the corticosteroid group, the percentage of predicted FEV1 increased from 27.4 to 38.4 percent. After bronchodilation, FEV1 in the placebo group increased from 25.7 to 32.2 percent. By contrast, it rose from 28.2 to 41.5 percent in the patients who received corticosteroid therapy.

The improvements in FEV1 after bronchodilation were most impressive in the first five days of treatment. During this time, the increase in FEV1 after bronchodilation was 90 mL per day in patients who received corticosteroid therapy and 30 mL per day in those who did not receive it. Both groups reported rapid improvement in symptoms, with a trend toward greater improvement in patients treated with corticosteroids. The median length of hospital stay was significantly shorter in patients who received corticosteroid therapy. At six weeks, the percentage of predicted FEV1 after bronchodilation did not differ significantly in the two treatment groups.

The authors conclude that low-dose corticosteroid therapy provides short-term benefits in patients with severe exacerbations of COPD.

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