EARLY CORTICOSTEROID USE IN ACUTE EXACERBATIONS OF CHRONIC AIR-FLOW OBSTRUCTION

To determine the benefit of early steroid use in acute exacerbations o f chronic airflow obstruction in the ED, 113 patients with an average age of 66 years, acute or chronic dyspnea, an FEV(1) of <60% and FEV(1 )/FVC ratio of <60% were included in a randomized, double blinded, int erventional clinical trial, All patients received the same bronchodila tor treatment, At 6 hours the steroid-treated group showed a 21.71 L/m in improvement in PEFR (P<.05) and 0.14 L improvement in FEV(1) (P < . 05), while the nonsteroid group showed insignificant improvements of 5 .52 L/min and 0.02 L, respectively, Of those patients receiving steroi ds, 22 achieved >40% improvements in PEFR by 6 hours and 17 achieved s imilar results in FEV(1), whereas of those not receiving steroids, 13 and 8, respectively, achieved improvements, Within 24 hours of observa tion in the ED, 16 patients receiving steroids were discharged and non e relapsed within 2 weeks, Of those not receiving steroids, only 10 we re discharged and 3 returned with exacerbations, Although early respon se to steroids in chronic airflow obstruction is variable, the overall medical and cost benefits justify their early use in acute exacerbati ons. (Copyright (C) 1996 by W.B. Saunders Company)