From the Guidelines
A common taper steroid dose for COPD exacerbation is prednisone 40mg daily for 5 days with no taper, as recommended by the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1. This approach has been shown to shorten recovery time, improve lung function, and reduce the risk of early relapse, treatment failure, and length of hospital stay 1. Alternatively, if a taper is preferred, one could use prednisone starting at 40mg daily for 3 days, then 30mg daily for 3 days, then 20mg daily for 3 days, and finally 10mg daily for 3 days (total 12-day course). Some key points to consider when using steroids for COPD exacerbations include:
- Reducing airway inflammation, decreasing mucus production, and improving bronchodilation 1
- Common side effects such as hyperglycemia, mood changes, insomnia, and increased appetite
- Patients should take the medication with food to reduce stomach irritation, and those with diabetes should monitor blood glucose levels more frequently during treatment
- Methylprednisolone can also be used, typically starting with 125mg IV every 6 hours for hospitalized patients, transitioning to oral prednisone when improved 1. It's worth noting that the 2017 European Respiratory Society/American Thoracic Society guideline also supports the use of oral corticosteroids in conjunction with other therapies in all patients admitted to hospital with an exacerbation of COPD 1.
From the FDA Drug Label
The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. After a favorable response is noted, the proper maintenance dosage should be determined by decreasing the initial drug dosage in small increments at appropriate time intervals until the lowest dosage which will maintain an adequate clinical response is reached. If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly
For a COPD exacerbation, the FDA label does not provide a specific tapering dose. However, it recommends that after a favorable response is noted, the dosage should be decreased in small increments at appropriate time intervals until the lowest dosage that maintains an adequate clinical response is reached. When stopping the drug after long-term therapy, it is recommended to withdraw gradually rather than abruptly 2. Key points to consider when tapering the dose include:
- Decrease the dose in small increments
- Decrease at appropriate time intervals
- Aim for the lowest effective dose
- Gradually withdraw the drug when stopping after long-term therapy.
From the Research
Taper Steroid Dose for COPD Exacerbation
- The optimal corticosteroid regimen for managing an acute exacerbation of chronic obstructive pulmonary disease (COPD) is still a topic of debate 3.
- A study suggests that a short-course corticosteroid taper in critically ill patients with COPD is associated with reduced hospital length of stay and decreased corticosteroid exposure without increased risk of treatment failure 4.
- Consistent with clinical guideline recommendations, safety and efficacy data support the use of low-dose corticosteroid regimens such as prednisone 40 mg orally once/day for 10-14 days in most patients with an acute exacerbation of COPD 3.
- Tapering of systemic corticosteroid regimens, although a common practice, is unnecessary in most circumstances, and the risk for hypothalamic-pituitary-adrenal-axis suppression is negligible when low-dose, short-course corticosteroid regimens are used 3.
- An example of a taper steroid dose for COPD exacerbation could be:
Considerations
- The use of systemic corticosteroids is associated with several adverse effects that are dose and/or duration dependent 3.
- Higher dose corticosteroid regimens may place patients at increased short-term and long-term risk, without additional clinical benefit 3.
- The risk of pneumonia with inhaled corticosteroid versus long-acting bronchodilator regimens in COPD should also be considered 5.