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Therapeutics
Glucocorticoids reduced short-term treatment failure in exacerbations of chronic obstructive pulmonary disease

https://doi.org/10.1136/ebm.5.1.18

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    (1999) N Engl J Med 340, 1941. Niewoehner DE, Erbland ML, Deupree, et al. for the Department of Veterans Affairs Cooperative Study Group.. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease.. Jun 24;. :. –7.
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 QUESTION: In patients who are hospitalised with exacerbations of chronic obstructive pulmonary disease (COPD), do glucocorticoids reduce the rate of first treatment failure?

    Design

    Randomised (allocation concealed*), blinded (clinicians and patients),* placebo-controlled trial with follow-up at 1, 3, and 6 months.

    Setting

    25 US Veterans Affairs medical centres.

    Patients

    271 patients (mean age 68 y, 99% men, 83% white) admitted to hospital with COPD. Inclusion criteria were age ≥50 years, history of ≥30 pack-years of smoking, and FEV1 ≤1.5 l or inability to have spirometry because of dyspnoea. Exclusion criteria were asthma, recent use of study drugs, or expected survival <1 year.

    Intervention

    Patients received broad-spectrum antibiotics for 1 week and inhaled β-adrenergic agonist, ipratropium bromide, and triamcinolone acetonide for 6 months. Medications other than study drugs …

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    Footnotes

    • Source of funding: Department of Veterans Affairs Cooperative Studies Program.

    • For correspondence: Dr D E Niewoehner, Pulmonary Section (111N), Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA. FAX 612-727-5634.

    • ↵* See glossary.