From the Guidelines
Corticosteroids are recommended for patients with COPD who develop pneumonia, with a suggested dose of 30-40 mg prednisone per day for 5 days. This recommendation is based on the 2017 European Respiratory Society/American Thoracic Society guideline 1, which supports the use of systemic corticosteroids in the management of COPD exacerbations, including those with pneumonia. The benefits of corticosteroids in this context include shortening recovery time, improving lung function and hypoxemia, and reducing the risk of early relapse, treatment failure, and length of hospital stay.
Some key points to consider when using corticosteroids in patients with COPD and pneumonia include:
- The dose and duration of corticosteroids may vary depending on the individual patient's needs and response to treatment
- Oral prednisone is typically the preferred route of administration, but intravenous methylprednisolone can be used in hospitalized patients who are unable to take oral medications
- Corticosteroids should be used in conjunction with appropriate antibiotic therapy for the pneumonia, as well as the patient's regular COPD medications, including bronchodilators
- Potential side effects of short-term steroid use, such as hyperglycemia, mood changes, and sleep disturbances, should be monitored and managed as needed.
It's worth noting that the use of corticosteroids in patients with pneumonia without COPD is not routinely recommended, and the decision to use steroids in these patients should be made on a case-by-case basis. However, for patients with underlying COPD who develop pneumonia, the benefits of corticosteroids in reducing exacerbation severity and duration generally outweigh the risks, as supported by the guideline evidence 1.
From the Research
Current Recommendations for COPD Exacerbations with Pneumonia
- The use of systemic corticosteroids in patients with both COPD exacerbation and pneumonia has been evaluated in several studies 2, 3, 4, 5.
- A study published in 2018 found that systemic corticosteroids may not provide a clinical benefit to patients with an AECOPD and pneumonia 2.
- Another study published in 2018 suggested that shorter courses of systemic corticosteroids (around five days) may be sufficient for treatment of adults with acute exacerbations of COPD, and may not lead to worse outcomes than longer courses (10 to 14 days) 3.
- A 2019 study found that hospital length of stay was shorter for patients prescribed standard-dose systemic corticosteroids, but no differences in other clinical outcomes were found 4.
- A 2014 systematic review found that systemic corticosteroids reduced the risk of treatment failure by over half compared with placebo, and also reduced the rate of relapse by one month 5.
Steroid Use in COPD Exacerbations
- Systemic corticosteroids are commonly used to treat COPD exacerbations, and have been shown to reduce the risk of treatment failure and relapse 5.
- However, the use of systemic corticosteroids can also increase the risk of adverse events, such as hyperglycaemia 5.
- The optimal duration of systemic corticosteroid treatment for COPD exacerbations is not well established, but shorter courses (around five days) may be sufficient 3.
Management of COPD Exacerbations
- Effective management of COPD exacerbations is crucial to prevent complications and improve patient outcomes 6.
- A comprehensive approach to managing COPD exacerbations includes pharmacologic and non-pharmacologic strategies, such as inhaled bronchodilators, systemic steroids, antibiotics, and pulmonary rehabilitation 6.
- Addressing areas of interest, such as smoking cessation and immunization with pneumococcal vaccine, can also improve patient outcomes and quality of life 6.