To the Editors:
I read with interest the recent article by Gunen et al. 1, wherein the authors presented the hypothesis that nebulised budesonide might be an alternative to systemic corticosteroids in the treatment of patients with exacerbations of chronic obstructive pulmonary disease (COPD). There are certain points which need discussing regarding their hypothesis of nebulised inhaled corticosteroids in COPD exacerbations.
First, exacerbations of COPD were considered to be a purely local disease: there is now enough evidence to support …