Randomized trials have shown that s...

Randomized trials have shown that systemic corticosteroids are effective in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD) that require hospitalization. However, no large, controll trials have examined outpatient use of oral corticosteroids for milder exacerbations of COPD Aaron and colleagues bearinged a randomized controlled trial of an outpatient course of prednisone in patients who were seen at an strait department for an exacerbation of symptoms of COPD

The trial initially disguiseed 1,087 patients who presented to an pressing necessity department with an exacerbation of COPD which was defined as the demeanor of at least two of the following three clinical criteria: increased dyspnea, increased sputum dimensions or increased purulence of sputum Patients included in the consideration were smokers who had been diagnosed with COPD for at least individual year. Patients also had to be at least 35 years of age and have evidence of irreversible airflow obstruction after bronchodilator use. Exclusion criteria included being admitted to the hospital; the use of corticosteroids in the difficulty department or within the previous 30 days; and a history of reversible obstructive disease, attendant pneumonia, or congestive heart failure. The 147 make submissives who met the inclusion criteria and signed concord forms were randomized to receive oral prednisone (40 mg formerly daily for 10 days) or a matching placebo. the one and the other groups received oral antibiotics (sulfamethoxazole-trimethoprim or doxycycline) and a 30-day course of inhaled albuterol (two blow in puffss four times daily) and inhaled ipratropium (three quick blasts four times daily).

The rate of patient relapse, defined as an unscheduled visit to a physician's office or urgency department within 30 days of randomization, was 27 percent in those receiving prednisone and 43 percent in those receiving placebo. Spirometric measures were significantly improved on the use of prednisone. After 10 days, the forced expiratory whirl in one second was improved at 34 percent in those receiving prednisone compared with 15 percent of those taking antibiotics and bronchodilators alone. Quality-of-life views showed decreased dyspnea-related scores with steroid use, moreover no significant change in life-quality status. No serious adverse forces were noted with prednisone use, nevertheless more patients in the prednisone collection reported increased appetite, weight gain, insomnia, and symptoms of depression or anxiety.

The authors finish that a 10-day course of oral prednisone in patients with exacerbations of COPD who do not require hospitalization is associated with fewer relapses in COPD symptoms after treatment and improved spirometric measures of lung function.

Aaron SD et al. Outpatient oral prednisone after pass treatment of chronic obstructive pulmonary disease. N Engl J M June 26 2003;348:2618-25

EDITOR'S NOTE: Careful inclusion and exclusion criteria help to make secure that a proposed intervention is targeted to an appropriate population. However, when sole 14 percent of the initially protectioned patients are enrolled in a trial, undivided has to wonder if too many clinical hairs have been split. The terminates of this study might have been generalized more easily if fewer make subordinates had been excluded. Most physicians treating patients with chronic obstructive pulmonary disorder have to do in the way that in the setting of co-morbidities and would not have pre- and post-bronchodilator spirometry data readily available.--B.Z.

COPYRIGHT 2004 American Academy of Family Physicians

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