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Background: COPD guidelines report that systemic corticosteroids are preferred over inhaled corticosteroids in the treatment of exacerbations, but the inhaled route is considered to be an optionin the absence of other treatment options. We have investigated the effects of the inhaled corticosteroids on clinical findings. METHODS: Three hundred fourteen patients with COPD and COPD exacerbations (mainly recurrent and subalar) were treated by the same doctors from December 2005 to December 2008. Two hundred and twenty-five were treated with inhaled corticosteroids and the remainder were given inhaled corticosteroid (oral corticosteroids, intranasal corticosteroids, and inhalation corticosteroids) or placebo. We used data from the clinical examinations, using the Acute and Metabolic Response Scale score (AMRS-A, P = 0.011), and the Clinical Global Impression of Change score (CGI-C, P = 0.01). RESULTS: Two days prior to initiating an inhaled dose of corticosteroid, the AMRS score rose up to 24. In the placebo group, the AMRS score rose up to 22. The differences between treatment with corticosteroids (mainly inhaled) or placebo (mostly oral) in the AMRS scores remained after adjustment for changes in body mass index, weight, or diastolic blood pressure. In the AMRS-A score, the mean decrease for the corticosteroids group was −17.3, whereas the mean increase for the placebo group was −27.9. In the CGI-C score, the mean increase for the corticosteroids group was +12.9, while the mean decrease was −2.0. CONCLUSIONS: Our results suggest that inhaled corticosteroids in the treatment is superior to oral corticosteroids for the treatment of COPD exacerbations. Copyright © 2015 Elsevier Ltd and European Society for Metabolic and Cardiovascular Diseases. All rights reserved. Similar articles: