和之前COPDAE用抗生素預後會較好的同一group做的，用oral prednisolone 20-80mg/day就可以了

Oral Corticosteroids as Effective as Intravenous Dosing in COPD Exacerbations

Although given at lower doses, oral corticosteroids provide the same outcomes in acute exacerbations of chronic obstructive pulmonary disease (COPD) as higher intravenous doses, according to a study in JAMA.

Despite guidelines recommending use of the low-dose oral route, researchers found that the higher-dose intravenous route was used initially in 92% of some 80,000 patients admitted to over 400 U.S. hospitals. The primary outcome measure — a composite of the need for mechanical ventilation after the second hospital day, death during hospitalization, or readmission for COPD within 30 days — was no worse in orally treated patients.

The authors conclude that the initial use of high-dose intravenous therapy "does not appear to be associated with any measurable clinical benefit," and has the added dangers associated with intravenous therapy as well as higher costs. Editorialists say that the results "are sufficient to take action to change practice now."

LINK(S):

JAMA article (Free abstract; full text requires subscription)

JAMA editorial (Subscription required)

Published in Physician's First Watch June 16, 2010


https://docs.google.com/fileview?id=0B278nGJMQBk7MmZhNDI3ZGMtNGQ0My00NjdlLWJjMWEtMmFhZjJiM2IwZDIw&hl=zh_TW

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