To the Editor: In a retrospective analysis of 79 985 patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (COPD) and treated with systemic corticosteroids in the first 2 hospital days, Dr Lindenauer and colleagues1 suggested that oral treatment was not worse than intravenous treatment. Although the study was considered well designed,2 we remain concerned about possible pitfalls in the methodology despite the large sample size and statistical methods.
Chang KC, Leung CC, Kong FY. Corticosteroid Administration and Treatment Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. JAMA. 2010;304(14):1554-1556. doi:10.1001/jama.2010.1438