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Background: This study was designed to evaluate the hypothesis that nebulized budesonide (NB) might be an alternative to systemic corticosteroids (SC) in the treatment of patients with exacerbations of COPD (ECOPD). Methods: Patients, hospitalized with ECOPD (n=159), were randomized into three groups. Group I received only standard bronchodilator treatment (SBDT), Group II received SC (40 mg prednisolon) plus SBDT, and Group III received NB (1500 mcg qid) plus SBDT. Improvement during 10-day hospitalization, and exacerbation and re-hospitalization rates after discharge were compared. Results: While mean age was 64,1±8,9 years (F/M=0,1), mean FEV1 at admission was found 37,2±12,2 % predicted. Arterial blood gases and spirograms recovered faster in Group II and III. While improvements in PaO2 and FVC in Group II, and improvements in PaO2, FVC and FEV1 in Group III became significant at 24-hour control, first significant improvement in Group I appeared in SaO2 at 72-hour control. Mean improvement in PaO2 at 10-day were 9 and 8 mmHg higher in Group II and III respectively than Group I (p<0,05). Blood glucos