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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 option. In a study by Caulo et al., inhaled corticosteroids were effective in relieving symptomatic exacerbations in COPD.11 The studies by Caulo and her colleagues are observational, but preliminary data are emerging that suggest that systemic corticosteroids may be preferable for patients with worsening asthma in whom there is a poor response to oral corticosteroids.12–14 In contrast to inhaled corticosteroids, systemic corticosteroids are not as beneficial in the treatment of asthma in patients with an exacerbation. Sensory symptoms in COPD: Accelerated mucociliary turnover and a decreased mucosal barrier to mucosae and bacterial adhesion, are thought to be involved in the development of sensory symptoms, particularly in COPD.15,16 Somatic exacerbations: A study of 661 patients with COPD found that patients with symptoms of COPD had reduced airway capacity compared with controls. Risk of exacerbations may be increased by patients who are experiencing symptoms of chronic asthma, lung impairment, and increased severity. Preventive and treatment: Several therapies have been evaluated for the treatment of exacerbations in COPD. Several approaches have been tested, including oral corticosteroids and inhaled corticosteroids. The use of inhaled corticosteroids was associated with a higher prevalence of mild exacerbations and respiratory symptoms compared with oral corticosteroids.17–19 The combination of both the inhaled corticosteroids and systemic corticosteroids may be the most effective method for patients with persistent exacerbations. Rigorous evidence supports the use of systemic corticosteroids (a combination of inhaled corticosteroid and systemic corticosteroid) in COPD.20–26 Corticosteroids have also been shown to be effective in COPD patients with moderate to severe exacerbations who do not respond to other therapies.27 The use of oral corticosteroids has been associated with a higher prevalence of moderate and severe exacerbations compared with inhaled corticosteroids.28 Additionally, patients who use oral corticosteroids have a higher prevalence of moderate and severe exacerbations compared with patients who do not use oral steroids.28 Use of systemic corticosteroids in COPD has been associated with respiratory symptomatology with more frequency than that observed in controls.25 The most recent recommendation from the Similar articles: