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Systemic Glucocorticoids in Severe Exacerbations of COPD^*

Abdullah Sayiner, MD; Zeynep Ayfer Aytemur, MD; Murat Cirit, MD and pek Ünsal, MD

^* From the Department of Chest Diseases, Ege University Medical School, Izmir, Turkey.

Correspondence to: Abdullah Sayiner, MD, Ege Üniversitesi Tip Fakültesi, Göüs Hastaliklari A.D., Bornova, zmir 35100, Turkey; e-mail: asayiner{at}med.ege.edu.tr

Objective: This study aimed to compare the efficacies of 3-day and 10-day courses of methylprednisolone (MP) treatment in severe COPD exacerbations necessitating 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 randomized into two groups: group 1 received MP, 0.5 mg/kg q6h for 3 days, and group 2 was administered the same dosage of MP for the first 3 days, after which it was tapered and terminated on the tenth day. There was no difference between the groups for age, baseline FEV₁, PaO₂, PaCO₂, and pH levels. One patient in group 1 who developed pneumothorax and one patient in group 2 who had steroid-related psychosis could not complete the study.

Results: Both groups showed significant improvements in PaO₂ and FEV₁ levels, but these were more marked in group 2 (p = 0.012 and p = 0.019, respectively). There was a significant increase in FVC levels in group 2 only (p = 0.003). Group 2 also had a more marked improvement in dyspnea on exertion. There was no difference between the two groups with regards to other parameters, including pH, PaCO₂ 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 group.

Conclusion: In severe COPD exacerbations, a 10-day course of steroid treatment is more effective than a 3-day course in improving the outcome, but has no benefit in reducing exacerbation rates.

Key Words: COPD • exacerbation • forced expiratory volume • methylprednisolone • steroids

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