Systemic glucocorticoids in severe exacerbations of COPD

Objective: This study aimed to compare the efficacies of 3-day and 10-day c ourses of methylprednisolone (MP) treatment in severe COPD exacerbations ne cessitating hospitalization for respiratory failure. Design: Prospective, randomized, single-blind study, Setting: Tertiary-care center. Patients and methods: Thirty-six patients were included in the study and ra ndomized into two groups: group 1 received MP, 0.5 mg/kg q6h for 3 days, an d group 2 was administered the same dosage of MP for the first 3 days, afte r which it was tapered and terminated on the tenth day, There was no differ ence between the groups for age, baseline FEV1, Pao(2), Paco(2), and pH lev els. One patient in group 1 who developed pneumothorax and one patient in g roup 2 who had steroid-related psychosis could not complete the study. Results: Both groups showed significant improvements in Pao(2) and FEV1 lev els, but these were more marked in group 2 (p = 0.012 and p = 0.019, respec tively), There was a significant increase in FI'C levels in group 2 only (p = 0.003). Group 2 also had a more marked improvement in dyspnea on exertio n. There was no difference between the two groups with regards to other par ameters, including pH, Pace, levels, and other symptom scores. Six patients in group 1 and five patients in group 2 developed new exacerbations within the following 6 months. Hyperglycemia occurred in two patients in each gro up. Conclusion: In severe COPD exacerbations, a 10-day course of steroid treatm ent is more effective than a 3-day course in improving the outcome, but has no benefit in reducing exacerbation rates.