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
Design: Prospective, randomized, single-blind
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.