Dexamethasone vs Hydrocortisone in Management of Exacerbated Chronic Obstructive Pulmonary Disease Patients: A Randomized Controlled Trial

Background: Different types of corticosteroids with different characteristics, such as hydrocortisone and dexamethasone, have been used in treatment of exacerbated chronic obstructive pulmonary disease but drug of choice unclear. The main goal of present study was to compare the efficacy of hydrocortisone and dexamethasone on clinical symptoms, peak expiratory flow, oxidative stress factors and inflammatory mediators in patients with exacerbation chronic obstructive pulmonary disease. Methods: In this single-blind randomized clinical trial study, 70 eligible patients with chronic obstructive pulmonary disease exacerbations, were selected and randomly divided into two groups. The patients in group A received 8 mg of intravenous dexamethasone daily and group B received 200 mg of intravenous daily hydrocortisone in 4 doses of 50 mg until discharge. Clinical symptoms, and peak expiratory flow measured in before intervention (day 1), after intervention (day 2) and discharge day. However, oxidative stress factors and inflammatory mediators were evaluated in day 1 and discharge day. Moreover, the probable complications of both drugs measured and scaled 1-4 by researcher. Results: The baseline characteristics of the two groups were similar (p < 0.05). Between groups comparisons showed significant differences in the patients’ clinical indicators for shortness of breath (P=0.02), sputum volume (p=0.01), and oxygen saturation of arterial blood (p=0.02). However, these differences were related to the first day, and no statistically significant differences was observed on the second or discharged days. Intragroup comparison revealed that the prescription of both dexamethasone and hydrocortisone led to significant improvement in the patients’ clinical symptoms; peak expiratory flow, Shortness of breath, Sputum volume, Sputum viscosity, Cough, and O2 saturation of both groups (P=0.001). Comparison of treatment outcomes showed a significant increase of edema in Hydrocortisone group (P = 0.009; (5.7 percent versus 17 percent for dexamethasone versus hydrocortisone, respectively). Conclusion: The results of the present study showed that Dexamethasone and Hydrocortisone are the same in improving important clinical symptoms, peak expiratory flow and have similar efficacy on inflammation and oxidative stress in patients with COPD exacerbation. Therefore both of them are recommended, but Dexamethasone is better and safer in patients with history of edema.