Dose of Corticosteroids in COPD
Dose of Corticosteroids in COPD
COPD (chronic obstructive pulmonary disease) is a long-lasting lung disease usually caused by
 long-term smoking. COPD can get worse, making people sick enough to need hospitalization.
 Corticosteroids are very effective and are almost always used, but nobody knows the right
 dose. High doses may work better but could cause more side effects than low doses. Typical
 treatment lengths last at least one week. This study will be comparing two common regimens:
 either 40mg of corticosteroids daily (low dose), or 80mg of corticosteroids daily (high
 dose). It is unknown which regimen works better..
The goal of the study is to determine whether a high-dose corticosteroid regimen in patients
 admitted to the hospital with COPD exacerbations is associated with better clinical outcomes
 and at acceptable risk of adverse effects compared to a low-dose corticosteroid regimen. Our
 hypothesis is that high-dose corticosteroids is associated with a decreased rate of treatment
 failure, shorter length of hospital stay, and improved quality of life with similar risk of
 adverse effects. The study population includes patients ≥ 40 years-old with a ≥ 10 pack-years
 smoking history and a diagnosis of COPD, emphysema, or chronic bronchitis who present to the
 emergency room with increased dyspnea, increased sputum, or increased cough that requires
 admission to the hospital. We will perform a prospective, randomized, double-blinded study to
 determine if a high-dose corticosteroid regimen, which is already in use in clinical
 practice, decreases treatment failure compared to a low-dose corticosteroid regimen that is
 based on national consensus guidelines.
Inclusion Criteria:

 i. Patients with a diagnosis of COPD, emphysema, or chronic bronchitis ii. Age ≥ 40
 years-old iii. Smoking history ≥ 10 pack-years iv. Presentation to the emergency room with
 increased dyspnea, increased sputum, or increased cough v. Admission to the hospital

 Exclusion Criteria:

 i. Alternative diagnosis for cause of dyspnea, increased sputum or cough ii. Patients who
 requires intubation at time of recruitment iii. Patients who are unable to give consent iv.
 Patients who are pregnant or could be pregnant or are currently breast-feeding v. Women of
 child-bearing age who cannot use methods of contraception as described in the consent,
 including condoms, female condoms, cervical caps, diaphragms, and intra uterine devices.

 vi. Patients who were previously entered into the trial and are re-admitted to the hospital
 with a new COPD exacerbation.