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Steroids in acute exacerbations of chronic obstructive pulmonary disease: are nebulized and systemic forms comparable?

Gunen, Hakana; Mirici, Arzub; Meral, Mehmetc; Akgün, Metinc

Current Opinion in Pulmonary Medicine: March 2009 - Volume 15 - Issue 2 - p 133–137
doi: 10.1097/MCP.0b013e32832185da
Obstructive, occupational and environmental diseases: Edited by Basil Varkey

Purpose of review Systemic corticosteroids are strongly recommended in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD). As COPD patients are usually elderly and are relatively immobile, side effects of systemic corticosteroids frequently outweigh their beneficial effects. On the contrary, nebulized corticosteroid solutions have a negligible systemic side-effect profile. In this review, as an alternative to systemic corticosteroids, the place of nebulized corticosteroids in exacerbation periods of COPD was summarized.

Recent findings The number of trials in the literature is increasing. Regarding the available data, high dose nebulized budesonide was found as effective as systemic corticosteroids in exacerbations of COPD. The side-effect profile, blood glucose level in particular, is better for nebulized budesonide.

Summary Findings from recent studies are giving a positive impression on the role of high dose nebulized budesonide in exacerbations of COPD. However, larger and statistically high powered trials testing different types of nebulized corticosteroid solutions with varying dosages are still lacking. Before recommending the routine use of nebulized corticosteroids in exacerbations, present findings need to be confirmed with further studies of high quality.

aDepartment of Pulmonary Medicine, Faculty of Medicine, Inonu University, Malatya, Turkey

bDepartment of Pulmonary Medicine, Faculty of Medicine, Canakkale 18 Mart University, Canakkale, Turkey

cDepartment of Pulmonary Medicine, Faculty of Medicine, Ataturk University, Erzurum, Turkey

Correspondence to Hakan Gunen, MD, Chief, Turgut Ozal Research Center, Department of Pulmonary and Sleep Medicine, Malatya 44069, Turkey Tel: +90 422 3410660 ext. 3808; fax: +90 422 3411000; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.