Early corticosteroid use in acute exacerbations of chronic airflow obstruction

To determine the benefit of early steroid use in acute exacerbations of chronic airflow obstruction in the ED, 113 patients with an average age of 66 years, acute or chronic dyspnea, an FEV(1) of <60% and FEV(1)/FVC ratio of <60% were included in a randomized, double blinded, interventional clinical trial, All patients received the same bronchodilator treatment, At 6 hours the steroid-treated group showed a 21.71 L/min improvement in PEFR (P<.05) and 0.14 L improvement in FEV(1) (P < .05), while the nonsteroid group showed insignificant improvements of 5.52 L/min and 0.02 L, respectively, Of those patients receiving steroids, 22 achieved >40% improvements in PEFR by 6 hours and 17 achieved similar results in FEV(1), whereas of those not receiving steroids, 13 and 8, respectively, achieved improvements, Within 24 hours of observation in the ED, 16 patients receiving steroids were discharged and none relapsed within 2 weeks, Of those not receiving steroids, only 10 were discharged and 3 returned with exacerbations, Although early response to steroids in chronic airflow obstruction is variable, the overall medical and cost benefits justify their early use in acute exacerbations. (Copyright (C) 1996 by W.B. Saunders Company)