Eligible patients had to have at least 40 years of age
and COPD with an acute exacerbation episode,
which was defined as a non-gradual increase in at
least one of the three major symptoms dyspnoea,
sputum production and sputum purulence, supposedly
caused by an acute infection. COPD was
staged based on spirometry and severity of symptoms
(4), and the type of exacerbation as described
previously (26). Patients were excluded from the
trial if they had a history of (i) asthma, (ii) a severe
immune system disorder, (iii) a malignancy or
haematologic disorder, (iv) an obstructive pulmonary
disease caused by other reasons, e.g. tuberculosis
or (v) any other disease with known impact
on disease recovery such as diabetes mellitus,
congestive heart disorder, cardiomyopathy,
arrhythmia, severe hypertension or hepatic cirrhosis.
Patients were also excluded in case of (vi) an
increase of ‡12% of the pulmonary function after
using a bronchodilator (4); (vii) severe clinical
symptoms in addition to cor pulmonale and heart
failure, utilization of extra respiratory muscles,
and oxygen dependence (scale IV); (viii) requirement
for treatment with steroids or non-steroid