id	author	title	date	pages	extension	mime	words	sentences	flesch	summary	cache	txt
cord-007444-c9vu8ako	Sherk, Peter A.	The Chronic Obstructive Pulmonary Disease Exacerbation	2000-12-01		.txt	text/plain	9154	479	40	The three major bacterial pathogens isolated from patients with COPD during periods of both clinical stability and exacerbation are nontypeable Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella cafar~halis.~~ When FEV, is severely reduced, Enterobacteriaceae and Pseudomonas aeruginosa are also commonly detected.42 These organisms possess a wide array of virulence factors that allow them to evade clearance from the lower airways. Two randomized controlled trials evaluating the vaccine's efficacy among patients with COPD were unable to show statistically significant protective benefit.36, 69 A recent meta-analysis concluded that the vaccine provides partial protection against bacteremic pneumococcal pneumonia but not against other important outcomes, including bronchitis or mortality caused by pneumococcal infection. The dose of methylprednisolone was high (125 mg every 6 hours for 3 days) and resulted in significantly more hyperglycemia and, possibly, increased secondary infection rates.'06 In summary, the evidence from randomized, controlled trials supports the conclusion that among patients with acute exacerbations, oral or intravenous corticosteroids significantly increase the FEV, for up to 72 hours and likely reduce the risk for treatment failure.	./cache/cord-007444-c9vu8ako.txt	./txt/cord-007444-c9vu8ako.txt