Abstract：Objective To compare the therapeutic effects of two doses of glucocorticoids in the acute phase with moderate COPD. Methods  A total of 63 patients with acute COPD who were admitted to the respiratory department in our hospital from October 2018 to September 2019 were selected and randomly divided into observation group and control group. The patients in the observation group were treated with high dose glucocorticoid based on conventional treatment, and the control group were given low dose glucocorticoid. The treatment effect and the incidence of adverse reactions were compared between the two groups. Results The efficacy and the incidence of adverse reactions in the observation group were higher than those in the control group, and the differences between the two groups were statistically significant (all P＜0.05). Conclusion   High-dose glucocorticoids can significantly improve symptoms and lung function of patients with COPD, but increase the incidence of adverse reactions, and should be used cautiously in clinical practice.