Are IV or oral steroids better for treating chronic obstructive pulmonary disease (COPD) exacerbation?
—Harnek Singh, MD, Orangeburg, S.C.

Several studies have examined the relative benefit of parenteral vs. enteral corticosteroids in the treatment of COPD exacerbation. Both administration routes are equally efficacious when bioequivalent doses of corticosteroids are employed. The key is to treat early (within 72 hours of the exacerbation if possible) and with a sufficient dose of corticosteroids (methylprednisolone at a dose of approximately 120 mg/day in an adult or an equivalent dose of another corticosteroid). Systemic corticosteroid treatment for exacerbations is generally limited to two weeks. This finding of clinical equivalence of administration route is not surprising given the pharmacodynamics of the corticosteroid class. The selection of a particular route of administration is more dependent on patient-specific conditions, preference, and local custom.
—R. Steven Tharratt, MD, MPVM (115-21)

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