In the current issue of CHEST (see page 1741), de Jong and colleagues12 address the first of these two questions. They hypothesized that oral prednisolone is not inferior to IV prednisolone when administered in bioequivalent doses (60 mg) over 5 days to patients hospitalized for management of a severe AECOPD, followed by a gradual tapering regimen of oral prednisolone beginning with a dose of 30 mg/d for a total 11-day course. The authors found that the oral and IV routes resulted in equivalent rates of treatment failure (the primary end point, defined as death, ICU admission, rehospitalization for COPD, or the need to intensify pharmacotherapy). Secondary outcomes were also equivalent, including improvement in FEV1 and quality of life from the day of hospital admission and length of hospital stay. A strength of the study is its carefully controlled, double-blind, double-dummy experimental design with stratified allocation to the treatment arms to achieve balance between the two groups on potentially influential baseline features, so that the results are unlikely to be confounded by differences in disease severity, preadmission therapy, or prior exacerbation history. Other strengths are the inclusion of patients who had failed outpatient treatment with oral corticosteroids, thereby making the results relevant to real-world clinical scenarios, and the completeness of the follow-up data for accurate capture of treatment failures following hospital discharge. A weakness of the study, however, is the exclusion of patients with very severe exacerbations manifested by acute ventilatory failure or with significant comorbidities, so that the results cannot be extrapolated to these not uncommon subsets of patients hospitalized with a COPD exacerbation. A surprising finding is the relatively high treatment failure rate in both treatment groups at 90 days (61.7% and 56.3%), which is higher than the failure rate at a comparable time period in the study of Nieweoehner et al (37%).,10 A subanalysis suggests that differences between the two studies in entry criteria (the latter study excluded patients who had used systemic corticosteroids within the preceding 30 days) probably do not explain this discrepancy. However, the lower treatment failure rate in the study by Niewoehner et al10 might be attributable to the much higher 3-day initial and 15-day cumulative doses of prednisolone administered in that study (total of 1,680 mg) compared to the doses used in the current study over 11 days (405 mg). Future carefully designed trials will need to address the impact of different dosing regimens of systemic corticosteroids on outcomes in patients hospitalized with an AECOPD. Nonetheless, since doses were equivalent between the two treatment arms in the study of de Jong et al,12 their observations of similar efficacy in a head-to-head equivalence trial of oral vs IV corticosteroids provide convincing support for the more convenient and less costly oral route in the inpatient management of AECOPD whenever oral intake is feasible.