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Am Fam Physician. 2001;64(8):1419

The use of corticosteroids in the management of acute exacerbations of chronic obstructive pulmonary disease (COPD) is not well defined. Studies have demonstrated that the addition of corticosteroids to standard bronchodilator therapy improves airflow and gas exchange, more rapidly decreases dyspnea and results in fewer treatment failures. However, a 1998 meta-analysis concluded that corticosteroids are only marginally more effective than placebo. Because of the conflicting findings, Sayiner and colleagues compared the efficacy of three-day and 10-day courses of methylprednisolone in the treatment of acute COPD exacerbations.

The study was a randomized, prospective, single-blind study of patients with severe airway obstruction who presented to a tertiary care center for treatment of acute exacerbation. All enrolled patients had to meet criteria for hospitalization for their COPD exacerbation. Patients were randomly assigned to receive one of two treatment protocols. The first group was given methylprednisolone in a dosage of 0.5 mg per kg intravenously every six hours for three days, followed by intravenous placebo treatment for seven days. Patients in group 2 were given the same dosage of methylprednisolone for the first three days, then methylprednisolone in a dosage of 0.5 mg per kg every 12 hours for three days and then once daily for four days. The primary end points were forced expiratory volume in one second (FEV1) and arterial partial pressure of oxygen (PaO2) at days 3 and 10. Secondary end points included symptom scores, recurrence of exacerbations over six months and adverse events.

Both groups showed improvement in FEV1 and PaO2 measurements at days 3 and 10, but group 2 showed more significant improvement. In addition, patients in group 2 had a marked improvement in dyspnea on exertion. There was no significant difference in the frequency of exacerbations after discharge from the hospital between the two groups, and there were the same number of episodes of hyperglycemia. There were no other differences in reported adverse events.

The authors conclude that in patients with an exacerbation of severe COPD, a 10-day course of steroid treatment is more effective than a three-day course. This 10-day treatment regimen provided better short-term results and rarely caused adverse events. However, a 10-day course offered no advantage in reducing exacerbations.

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