Although the oral bioavailability of corticosteroids is excellent, many physicians persist in using IV steroids for patients with exacerbations of COPD.
In this study, 210 hospitalized adults older than 40 years with COPD and at least 24 hours of exacerbation were randomized to receive 5 days of oral or IV prednisolone (60 mg daily) followed by a tapering oral dose. Patients with a severe exacerbation (pH <7.26 or PaCO2 >9.3 kPa) were excluded. Allocation was concealed and patients were randomized using a “minimization protocol” that balances groups for key variables such as age, sex, smoking history, and supplemental oxygen use.
The primary outcome was treatment failure, defined as death, admission to the intensive care unit, readmission, or the need to intensify treatment. Groups were balanced at the start of the study, and analysis was by intent to treat; withdrawals and exclusions were uncommon and similar between groups.
No difference was noted between groups in the primary outcome either early (ie, within 2 weeks), late (ie, after 2 weeks), or overall. The treatment failure rate was relatively high in both groups, usually because of the need to intensify treatment.