Efficacy of two corticosteroid regimens in acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND

Studies comparing corticosteroids in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are lacking.

OBJECTIVE

To compare intravenous (IV) methylprednisolone (MP) followed by oral MP with IV hydrocortisone (HC) followed by oral prednisolone in patients with AECOPD.

METHODS

Ninety-seven patients with AECOPD were randomly allocated to Group A (n = 50) or Group B (n = 47). Group A patients were administered HC 200 mg 6 hourly until discharge, followed by prednisolone 0.75 mg/kg/day for 2 weeks; Group B patients were administered IV MP (125 mg bolus, followed by 40 mg 6 hourly) and then oral MP 0.6 mg/kg/day for 2 weeks. Clinical variables, peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV(1)) were assessed until discharge and again 2 weeks after discharge.

RESULTS

Baseline characteristics were comparable. Mortality, need for mechanical ventilation and acute exacerbation within 2 weeks of discharge were not significantly different between the two groups. However, at 2 weeks, Group B showed significant improvement over Group A in FEV(1) and PEF.

CONCLUSION

This study suggests that in AECOPD, IV MP followed by oral MP produced greater improvement in FEV(1) and PEF than IV HC followed by oral prednisolone, although there were no differences in need for ventilator support or in recurrence of exacerbation.