Systemic Glucocorticoids on Exacerbations of COPD
Systemic Glucocorticoids on Exacerbations of COPD
Source: Niewoehner DE, et al. N Engl J Med 1999;340:1941-1947.
Steroid therapy is commonly administered to patients with COPD at times of exacerbation, especially when exacerbation is sufficient to warrant hospitalization. Despite this practice being routinely applied, there is scant literature to support its efficacy either on immediate or long-term clinical end points. The current study (n = 271) evaluated the difference between treatment of COPD exacerbations requiring hospitalization with and without steroids. Outcomes assessed included first treatment failure, defined as death from any cause, need for intubation or mechanical ventilation, need for readmission due to COPD, or requirement for greater levels of pharmacologic therapy (e.g., adding theophylline, high-dose inhaled glucocorticoids, adding open-label systemic steroids). Also evaluated were changes in FEV-1, length of hospital stay, and death from any cause over a six-month follow-up period.
At admission, steroid was administered as IV methylprednisolone 125 mg q 6 h ´ 72 hours, followed by either a two-week or an eight-week progressively tapering course of once-daily prednisone, beginning with 60 mg/d.
Comment by Louis Kuritzky, MD
Steroids significantly reduced the rate of first failure in the first 90 days of the study. Length of hospital stay was significantly longer in the placebo group, and FEV1 improved more quickly in glucocorticoid recipients. Niewoehner and associates conclude that systemic steroids reduce treatment failure in the 90 days after an exacerbation, and that a two-week regimen is as effective as an eight-week regimen.
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