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Previous Volume 340:1941-1947 June 24, 1999 Number 25 Next

	Full Text PDF Editorial by Boushey, H. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods Although their clinical efficacy is unclear and they may cause serious adverse effects, systemic glucocorticoids are a standard treatment for patients hospitalized with exacerbations of chronic obstructive pulmonary disease (COPD). We conducted a double-blind, randomized trial of systemic glucocorticoids (given for two or eight weeks) or placebo, in addition to other therapies, for exacerbations of COPD. Most other care was standardized over the six-month period of follow-up. The primary end point was treatment failure, defined as death from any cause or the need for intubation and mechanical ventilation, readmission to the hospital for COPD, or intensification of drug therapy.

Results Of 1840 potential study participants at 25 Veterans Affairs medical centers, 271 were eligible for participation and were enrolled; 80 received an eight-week course of glucocorticoid therapy, 80 received a two-week course, and 111 received placebo. About half the potential participants were ineligible because they had received systemic glucocorticoids in the previous 30 days. Rates of treatment failure were significantly higher in the placebo group than in the two glucocorticoid groups combined at 30 days (33 percent vs. 23 percent, P=0.04) and at 90 days (48 percent vs. 37 percent, P=0.04). Systemic glucocorticoids (in both groups combined) were associated with a shorter initial hospital stay (8.5 days, vs. 9.7 days for placebo; P=0.03) and with a forced expiratory volume in one second that was about 0.10 liter higher than that in the placebo group by the first day after enrollment. Significant treatment benefits were no longer evident at six months. The eight-week regimen of therapy was not superior to the two-week regimen. The patients who received glucocorticoid therapy were more likely to have hyperglycemia requiring therapy than those who received placebo (15 percent vs. 4 percent, P=0.002).

Conclusions Treatment with systemic glucocorticoids results in moderate improvement in clinical outcomes among patients hospitalized for exacerbations of COPD. The maximal benefit is obtained during the first two weeks of therapy. Hyperglycemia of sufficient severity to warrant treatment is the most frequent complication.

Source Information

From the Veterans Affairs medical centers in Minneapolis (D.E.N.), Little Rock, Ark. (M.L.E., P.A.), Hines, Ill. (N.J.G.), and Long Beach, Calif. (R.W.L.); the Cooperative Studies Program Coordinating Center, West Haven, Conn. (R.H.D., D.C.); and the Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, N.M. (N.A.M.). Presented in part at the annual meeting of the American Thoracic Society, Chicago, April 24–29, 1998, and the annual meeting of the European Respiratory Society, Geneva, September 19–23, 1998.

Address reprint requests to Dr. Niewoehner at the Pulmonary Section (111N), Veterans Affairs Medical Center, 1 Veterans Dr., Minneapolis, MN 55417, or at niewo001{at}maroon.tc.umn.edu.

Full Text of this Article

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Glucocorticoids for Chronic Obstructive Pulmonary Disease
Kapur S., Kupfer Y., Tessler S., Niewoehner D. E., Erbland M., Collins D.
Extract | Full Text  
N Engl J Med 1999; 341:1772-1773, Dec 2, 1999. Correspondence

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