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Pulmonary Disease


Answer 3
  1. Systemic corticosteroids reduce hospital stays by 1 to 2 days. Recent randomized controlled trials3,4 established that systemic corticosteroids hasten recovery, reduce hospital stay, and reduce early treatment failure in patients with acute exacerbations of COPD. However, the studies did not demonstrate significant mortality benefit associated with the use of systemic corticosteroids. No more than 2 weeks of therapy should be given (unless patients are on chronic corticosteroids) because prolonged treatment may increase the readmission rate due to infectious complications. There is no reason to believe that intravenous therapy is inherently better than oral therapy. The exact dose of oral prednisone that should be given is unknown, but high doses are associated with a significant risk of side effects. Thirty to 40 mg of oral prednisone daily seems reasonable.

    REFERENCES
    3. Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. Department of Veterans Affairs Cooperative Study Group. N Engl J Med 1999; 340:1941-7.
    4. Davies L, Angus RM, Calverley PM. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet 1999;354:456-60.

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