Trials of steroids in patients with chronic airflow obstruction

Any patient with severe chronic airflow obstruction unresponsive to maximal bronchodilator therapy is worthy of a trial of steroids. This should consist of 30-40 mg prednisolone daily for two weeks, preceded by an adequate observation period and 1-2 weeks' treatment with placebo. Assessment of response should depend on symptoms, peak flow recordings and clinic spirometry. Only if there is substantial (greater than or equal to 15%) improvement should steroids be continued, preferably in the inhaled form or otherwise at the lowest oral dose that maintains improvement.