University of Minnesota, Minneapolis, MN
Correspondence to: S. Scott Nicholas, MD, FCCP, Eisenstadt Allergy & Asthma LLP, 221 Medical Arts Building, 825 Nicollet Mall, Minneapolis, MN 55402; e-mail: firstname.lastname@example.org
In the December 2007 issue of CHEST, de Jong, et al1compared the use of oral and IV prednisolone in the treatment of inpatients with COPD exacerbations. In an accompanying editorial, Tashkin2emphasized that the treatment failure rate at 90 days in both treatment groups was quite high (IV prednisolone group, 67%; oral prednisolone group, 56.3%). In an earlier study, Niewoehner et al3 had a much lower failure rate at a similar interval (37%) using a much higher prednisolone dose for a slightly longer interval. Tashkin2 rightly encouraged carefully designed trials to address the impact of different dosing regimes of systemic corticosteroids in hospitalized patients with acute exacerbations of COPD.
I would make a plea to compare the use of a single daily dose of the corticosteroid (as in the study by de Jong et al1) with comparable total but divided daily-dose regimens of prednisolone. These studies would be useful in both inpatient and outpatient settings and for patients with exacerbations of COPD, bronchial asthma, and other allergic illness. It is my firm clinical impression (albeit anecdotal) that divided dose administration of prednisolone is more effective and has a longer duration of action than single daily-dose administration. I am aware of the theoretical concern about more adrenal-pituitary axis disruption with the divided dose (and therefore more therapeutic effect), but because of the relatively short duration of these dosing schedules (ie, < 30 days), we do not see any adverse effects.
The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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