CONTROLLED TRIAL OF ORAL PREDNISONE IN OUTPATIENTS WITH ACUTE COPD EXACERBATION

Corticosteroids are often used in the outpatient treatment of acute ex acerbation of chronic obstructive pulmonary disease (COPD). To date, t here are few data documenting the benefit of this practice. The object ive of this randomized, double-blind, placebo-controlled trial was to assess the efficacy of corticosteroids in the outpatient treatment of COPD exacerbations. Twenty-seven patients presenting with acute COPD e xacerbation were studied. In addition to continuing their previous med ications and increasing their use of beta-agonists, patients were rand omized to receive a 9-d tapering dose of either oral prednisone or pla cebo. Treatment with prednisone rather than placebo resulted in a more rapid improvement in arterial PO2 (Pa-O2) (1.12 mm Hg/d versus -0.03 mm Hg/day; p = 0.002), alveolar-arterial oxygen gradient (A-aD(O2)) (- 1.16 mm Hg/d versus -0.03 mm Hg/day; p = 0.04), FEV(1) (0.05 L/d versu s 0.00 L/d; p = 0.006), and peak expiratory flow (PEF) (0.15 L/s/d ver sus 0.04 L/s/d; p = 0.009). Prednisone also resulted in fewer treatmen t failures (p = 0.002) and in a trend toward more rapid improvement in dyspnea scale scores. Outpatient treatment of acute COPD exacerbation with prednisone accelerates recovery of Pa-O2, A-aDo(2), FEV(1), and PEF, reduces the treatment failure rate, and improves subjective dyspn ea.