FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 348:2618-2625 June 26, 2003 Number 26 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Irwin, R. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background In this randomized, double-blind, placebo-controlled trial, we studied the effectiveness of prednisone in reducing the risk of relapse after outpatient exacerbations of chronic obstructive pulmonary disease (COPD).

Methods We enrolled 147 patients who were being discharged from the emergency department after an exacerbation of COPD and randomly assigned them to 10 days of treatment with 40 mg of oral prednisone once daily or identical-appearing placebo. All patients received oral antibiotics for 10 days, plus inhaled bronchodilators. The primary end point was relapse, defined as an unscheduled visit to a physician's office or a return to the emergency department because of worsening dyspnea, within 30 days after randomization.

Results The overall rate of relapse at 30 days was lower in the prednisone group than in the placebo group (27 percent vs. 43 percent, P=0.05), and the time to relapse was prolonged in those taking prednisone (P=0.04). After 10 days of therapy, patients in the prednisone group had greater improvements in forced expiratory volume in one second than did patients in the placebo group (mean [±SD] increase from base line, 34±42 percent vs. 15±31 percent; P=0.007). Patients in the prednisone group also had significant improvements in dyspnea, as measured by the transitional dyspnea index (P=0.04) and by the dyspnea domain of the Chronic Respiratory Disease Index Questionnaire (P=0.02), but not in health-related quality of life (P=0.14).

Conclusions Outpatient treatment with oral prednisone offers a small advantage over placebo in treating patients who are discharged from the emergency department with an exacerbation of COPD.

Source Information

From the Departments of Medicine (S.D.A., P.H., R.D.) and Emergency Medicine (I.G.S, J.A., G.D.), and the Ottawa Health Research Institute (K.L.V., E.Y., G.W.), University of Ottawa, Ottawa, Ont.; the Department of Emergency Medicine, Queen's University, Kingston, Ont. (R.B.); the Division of Emergency Medicine, University of Alberta, Edmonton, Alta. (B.H.R.); the Department of Emergency Medicine, London Health Sciences Centre, London, Ont. (J.D.); and St. Michael's Hospital, Toronto (D.C.) — all in Canada.

Address reprint requests to Dr. Aaron at the Division of Respiratory Medicine, Ottawa Hospital, General Campus, Rm. 1812F, 501 Smyth Rd., Ottawa, ON K1H 8L6, Canada, or at saaron{at}ottawahospital.on.ca.

Full Text of this Article

Related Letters:

Prednisone for Chronic Obstructive Pulmonary Disease
Busti A. J., Vervan M. D., Brouse S. D., Hurst J. R., Donaldson G. C., Wedzicha J. A., Rolla G., Bucca C., Salloum A., Elbaage T. Y., Soubani A. O., Aaron S., Dales R., Wells G.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:1288-1290, Sep 25, 2003. Correspondence

This article has been cited by other articles:

• Todd, D. C., McIvor, R. A., Pugsley, S. O., Cox, G. (2008). Approach to chronic obstructive pulmonary disease in primary care. cfp 54: 706-711 [Abstract] [Full Text]  
• Falk, J. A., Minai, O. A., Mosenifar, Z. (2008). Inhaled and Systemic Corticosteroids in Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 5: 506-512 [Abstract] [Full Text]  
• Quon, B. S., Gan, W. Q., Sin, D. D. (2008). Contemporary Management of Acute Exacerbations of COPD: A Systematic Review and Metaanalysis. Chest 133: 756-766 [Abstract] [Full Text]  
• Cazzola, M., MacNee, W., Martinez, F. J., Rabe, K. F., Franciosi, L. G., Barnes, P. J., Brusasco, V., Burge, P. S., Calverley, P. M. A., Celli, B. R., Jones, P. W., Mahler, D. A., Make, B., Miravitlles, M., Page, C. P., Palange, P., Parr, D., Pistolesi, M., Rennard, S. I., Rutten-van Molken, M. P., Stockley, R., Sullivan, S. D., Wedzicha, J. A., Wouters, E. F., on behalf of the American Thoracic Society/Europea, (2008). Outcomes for COPD pharmacological trials: from lung function to biomarkers. Eur Respir J 31: 416-469 [Abstract] [Full Text]  
• Vijayasaratha, K., Stockley, R. A. (2008). Reported and Unreported Exacerbations of COPD: Analysis by Diary Cards. Chest 133: 34-41 [Abstract] [Full Text]  
• Martinez, F. J. (2007). Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 4: 647-658 [Abstract] [Full Text]  
• de Jong, Y. P., Uil, S. M., Grotjohan, H. P., Postma, D. S., Kerstjens, H. A.M., van den Berg, J. W.K. (2007). Oral or IV Prednisolone in the Treatment of COPD Exacerbations: A Randomized, Controlled, Double-blind Study. Chest 132: 1741-1747 [Abstract] [Full Text]  
• Anzueto, A., Sethi, S., Martinez, F. J. (2007). Exacerbations of Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 4: 554-564 [Abstract] [Full Text]  
• Rabe, K. F., Hurd, S., Anzueto, A., Barnes, P. J., Buist, S. A., Calverley, P., Fukuchi, Y., Jenkins, C., Rodriguez-Roisin, R., van Weel, C., Zielinski, J. (2007). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary. Am. J. Respir. Crit. Care Med. 176: 532-555 [Abstract] [Full Text]  
• Beaulieu-Genest, L., Chretien, D., Maltais, F., Pelletier, K., Parent, J.-G., Lacasse, Y. (2007). Self-administered prescriptions of oral steroids and antibiotics in chronic obstructive pulmonary disease: are we doing more harm than good?. Chronic Respiratory Disease 4: 143-147 [Abstract]  
• Celli, B. R., Barnes, P. J. (2007). Exacerbations of chronic obstructive pulmonary disease. Eur Respir J 29: 1224-1238 [Abstract] [Full Text]  
• Aaron, S. D., Vandemheen, K. L., Fergusson, D., Maltais, F., Bourbeau, J., Goldstein, R., Balter, M., O'Donnell, D., McIvor, A., Sharma, S., Bishop, G., Anthony, J., Cowie, R., Field, S., Hirsch, A., Hernandez, P., Rivington, R., Road, J., Hoffstein, V., Hodder, R., Marciniuk, D., McCormack, D., Fox, G., Cox, G., Prins, H. B., Ford, G., Bleskie, D., Doucette, S., Mayers, I., Chapman, K., Zamel, N., FitzGerald, M., for the Canadian Thoracic Society/Canadian Respira, (2007). Tiotropium in Combination with Placebo, Salmeterol, or Fluticasone Salmeterol for Treatment of Chronic Obstructive Pulmonary Disease: A Randomized Trial. ANN INTERN MED 146: 545-555 [Abstract] [Full Text]  
• Gunen, H., Hacievliyagil, S. S., Yetkin, O., Gulbas, G., Mutlu, L. C., In, E. (2007). The role of nebulised budesonide in the treatment of exacerbations of COPD. Eur Respir J 29: 660-667 [Abstract] [Full Text]  
• Rodriguez-Roisin, R (2006). COPD exacerbations {middle dot} 5: Management.. Thorax 61: 535-544 [Abstract] [Full Text]  
• Vondracek, S. F., Hemstreet, B. A. (2006). Retrospective evaluation of systemic corticosteroids for the management of acute exacerbations of chronic obstructive pulmonary disease. Am J Health Syst Pharm 63: 645-652 [Abstract] [Full Text]  
• O'Donnell, D E, Parker, C M (2006). COPD exacerbations {middle dot} 3: Pathophysiology.. Thorax 61: 354-361 [Abstract] [Full Text]  
• Barnes, P. J., Stockley, R. A. (2005). COPD: current therapeutic interventions and future approaches. Eur Respir J 25: 1084-1106 [Abstract] [Full Text]  
• Man, W. D-C, Polkey, M. I, Donaldson, N., Gray, B. J, Moxham, J. (2004). Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study. BMJ 329: 1209- [Abstract] [Full Text]  
• Donohue, J. F., Ohar, J. A. (2004). Effects of Corticosteroids on Lung Function in Asthma and Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 1: 152-160 [Abstract] [Full Text]  
• Calverley, P. M. A. (2004). Effect of Corticosteroids on Exacerbations of Asthma and Chronic Obstructive Pulmonary Disease. Proc Am Thorac Soc 1: 161-166 [Abstract] [Full Text]  
• Denning, D. W. (2004). Aspergillosis in "Nonimmunocompromised" Critically Ill Patients. Am. J. Respir. Crit. Care Med. 170: 580-581 [Full Text]  
• Wilkinson, T. M. A., Donaldson, G. C., Hurst, J. R., Seemungal, T. A. R., Wedzicha, J. A. (2004). Early Therapy Improves Outcomes of Exacerbations of Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 169: 1298-1303 [Abstract] [Full Text]  
• Celli, B.R., MacNee, W., Agusti, A., Anzueto, A., Berg, B., Buist, A.S., Calverley, P.M.A., Chavannes, N., Dillard, T., Fahy, B., Fein, A., Heffner, J., Lareau, S., Meek, P., Martinez, F., McNicholas, W., Muris, J., Austegard, E., Pauwels, R., Rennard, S., Rossi, A., Siafakas, N., Tiep, B., Vestbo, J., Wouters, E., ZuWallack, R. (2004). Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 23: 932-946 [Full Text]  
• Buhl, R., Farmer, S. G. (2004). Current and Future Pharmacologic Therapy of Exacerbations in Chronic Obstructive Pulmonary Disease and Asthma. Proc Am Thorac Soc 1: 136-142 [Abstract] [Full Text]  
• (2004). Other articles noted. Evid. Based Med. 9: 31-32 [Full Text]  
• (2004). Other articles noted: 25 Jul 03 to 7 Nov 03. Evid. Based Nurs. 7: e1-1 [Full Text]  
• Celli, B. R. (2003). A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease. JAMA 290: 2721-2729 [Full Text]  
• Busti, A. J., Vervan, M. D., Brouse, S. D., Hurst, J. R., Donaldson, G. C., Wedzicha, J. A., Rolla, G., Bucca, C., Salloum, A., Elbaage, T. Y., Soubani, A. O., Aaron, S., Dales, R., Wells, G. (2003). Prednisone for Chronic Obstructive Pulmonary Disease. NEJM 349: 1288-1290 [Full Text]  
• (2003). Outpatient Oral Prednisone for COPD. JWatch Emergency Med. 2003: 1-1 [Full Text]  
• (2003). Prednisone for Outpatient Treatment of COPD Exacerbations. JWatch General 2003: 3-3 [Full Text]  
• Irwin, R. S., Madison, J. M. (2003). Systemic Corticosteroids for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. NEJM 348: 2679-2681 [Full Text]