It is now 20 years since Richard Albert and
colleagues1 published the first randomized, double-blind,
placebo-controlled trial of systemic glucocorticoids in the treatment
of acute exacerbations of COPD. In this landmark study, a regimen of IV
methylprednisolone four times daily for 3 days was found to produce an
early increase in FEV1 relative to placebo treatment.
Continued improvement was observed up to 72 h with ongoing