Oral Prednisolone in Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)
Oral Prednisolone in Severe Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)
Evaluation of systematic administration of oral prednisolone (1mg/Kg/day) as an add on
 therapy in Chronic Obstructive Pulmonary Disease (COPD) patients admitted to intensive care
 unit (ICU) for severe exacerbation of COPD. Patients with pneumonia are excluded.

 Randomization is stratified according to ventilatory support: non invasive or conventional
 ventilation.The major outcome is the ICU mortality rate in overall population and stratified
 according to ventilatory mode (noninvasive ventilation (NIV) versus conventional).

 Secondary outcomes are superinfection necessitating a new antibiotic course, Length of
 mechanical ventilation (MV) (and ventilatory free days), Length of ICU stay, The frequency of
 gastric bleeding episodes that of frequency of hyperglycemic episodes.
Inclusion Criteria:

 -  All COPD patients (according to the ATS definition) experiencing acute exacerbation
 originating in acute respiratory failure and requiring ICU admission will be included
 in the study.

 COPD exacerbation is defined by the increased frequency of cough, volume and purulence of
 sputum and that of wheeze.

 Acute respiratory failure is defined by the presence of hypercapnia with PaCO2 >45mmHg
 associated with pH > 7.35 and signs of respiratory muscle fatigue (contraction of accessory
 respiratory muscles, thoracoabdominal swinging ,..).

 Exclusion Criteria:

 -  Asthmatic patients defined by a reversible obstructive disease following nebulized
 bronchodilators,

 -  Patients with uncontrolled left heart failure,

 -  AECOPD patients with a radiologically documented pneumonia,

 -  Systemic corticotherapy within 30 days before screening,

 -  contra-indication to corticosteroids (active gastroduodenal ulcer, uncontrolled
 sepsis, etc. ..)