From the Guidelines
Dexamethasone is a recommended corticosteroid for managing acute exacerbations of COPD, typically administered at a dose equivalent to 30-40 mg of prednisone per day for 5-7 days, as suggested by the 2014 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1.
Key Points for Management
- The goal of treatment is to minimize the negative impact of the current exacerbation and prevent subsequent events, as stated in the 2017 Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease report 1.
- Systemic corticosteroids, such as dexamethasone, improve lung function, oxygenation, and shorten recovery time and hospitalization duration, as highlighted in the same report 1.
- The duration of corticosteroid therapy should not exceed 5-7 days, according to the 2017 GOLD executive summary 1.
- Dexamethasone can be given orally or intravenously, depending on the patient's condition, with oral administration preferred when possible.
- Clinicians should monitor for potential side effects, including hyperglycemia, mood changes, insomnia, and increased infection risk, particularly in diabetic patients, who require close blood glucose monitoring.
Optimal Management
- Dexamethasone should be used alongside bronchodilators and, when appropriate, antibiotics for optimal management of COPD exacerbations.
- Short-acting inhaled β2-agonists, with or without short-acting anticholinergics, are recommended as the initial bronchodilators to treat an acute exacerbation, as per the 2017 GOLD executive summary 1.
- Maintenance therapy with long-acting bronchodilators should be initiated as soon as possible before hospital discharge, as suggested in the same report 1.
Considerations
- Prolonged use of corticosteroids should be avoided due to the increased risk of adverse effects such as osteoporosis, adrenal suppression, and muscle weakness, as noted in the prevention of acute exacerbations of COPD guideline by the American College of Chest Physicians and Canadian Thoracic Society 1.
From the Research
Role of Dexmethasone in Managing Acute Exacerbations of COPD
- Dexmethasone, a corticosteroid, plays a significant role in managing acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) by reducing the risk of treatment failure and relapse 2.
- Systemic corticosteroids, such as dexmethasone, have been shown to reduce the risk of treatment failure by over half compared with placebo, with a median treatment duration of 14 days 2.
- The evidence suggests that systemic corticosteroids can shorten the length of stay in hospital inpatients not requiring assisted ventilation in ICU and give earlier improvement in lung function and symptoms 2.
Comparison of Oral and Parenteral Corticosteroid Administration
- There is no significant difference in the primary outcomes of treatment failure, relapse, or mortality between oral and parenteral corticosteroid administration 2.
- However, parenteral administration is associated with a significantly increased rate of hyperglycaemia compared with oral administration 2.
Guidelines and Recommendations for Corticosteroid Use in COPD
- Current COPD guidelines often recommend systemic corticosteroids universally to all patients with acute exacerbations, but criteria for treatment with antibiotics are mainly based on an increase in respiratory symptoms 3.
- The GOLD guidelines recommend initial dual therapy with a LABA and LAMA for COPD patients with a high risk of exacerbations, with Inhaled Corticosteroids (ICS) added for specific phenotypes or continued exacerbations 4.
- Earlier initiation of triple therapy in high-risk, symptomatic patients may show substantial benefits, including improved quality of life, and minimize systemic corticosteroid exposure 4.