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A 2010 observational study suggested that relatively low-dose oral corticosteroids were as good as — or better than — high-dose parenteral steroids in hospitalized patients with chronic obstructive pulmonary disease (COPD) exacerbations, but intensive care unit (ICU) patients were excluded from that study (NEJM JW Gen Med Jun 24 2010). Whether these results can be extrapolated to patients admitted to ICUs is unclear.
Researchers evaluated 17,239 patients (77% older than 60; 31% tobacco users) with COPD exacerbations who were admitted to ICUs at 473 U.S. hospitals. Nearly one third of patients received noninvasive ventilation; 15% were intubated. Almost all patients received antibiotics and bronchodilators. Methylprednisolone doses were categ…