What is the recommended steroid dose for managing Chronic Obstructive Pulmonary Disease (COPD) exacerbations?

From the Guidelines

For COPD exacerbations, the recommended steroid regimen is oral prednisone at a dose of 40mg daily for 5 days. This short course of systemic corticosteroids is effective in reducing recovery time, improving lung function, and decreasing treatment failure rates, as supported by the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1. Alternative options include prednisolone 30-40mg daily or methylprednisolone 32mg daily, also for 5 days. The use of systemic corticosteroids in COPD exacerbations is further reinforced by the European Respiratory Society/American Thoracic Society guideline, which concludes that systemic corticosteroids are beneficial in the management of COPD, shortening recovery time, improving lung function and hypoxemia, and reducing the risk of early relapse, treatment failure, and length of hospital stay 1.

The duration of therapy should not exceed 5-7 days, as longer courses do not provide additional benefits but increase the risk of side effects such as hyperglycemia, fluid retention, mood changes, and increased infection risk 1. For hospitalized patients with severe exacerbations, intravenous methylprednisolone may be used initially at 60-125mg every 6 hours for 48 hours before transitioning to oral therapy. Inhaled corticosteroids alone are not sufficient for acute exacerbations but should be continued as part of maintenance therapy. The choice between oral and intravenous corticosteroids should be based on the patient's condition and the potential for adverse effects, with oral corticosteroids being the preferred route of administration due to similar efficacy and lower risk of adverse effects compared to intravenous corticosteroids 1.

Key points to consider in the management of COPD exacerbations include:

• The use of short-acting inhaled bronchodilators as the initial treatment
• The addition of systemic corticosteroids to reduce airway inflammation and improve lung function
• The potential use of antibiotics in cases of suspected bacterial infection
• The consideration of noninvasive ventilation in patients with acute respiratory failure
• The importance of continuing maintenance therapy, including inhaled corticosteroids, to prevent future exacerbations.

From the Research

COPD Exacerbation Steroid Dose

The recommended steroid dose for managing Chronic Obstructive Pulmonary Disease (COPD) exacerbations is a topic of interest in the medical field.

• Current guidelines recommend that patients with acute exacerbations of COPD should be treated with systemic corticosteroid for seven to 14 days 2.
• However, studies have shown that shorter treatment durations, such as five days, may be sufficient and can reduce the risk of adverse effects 2, 3.
• A study published in JAMA found that 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up 3.
• Another study found that hospital length of stay was shorter for patients prescribed standard-dose systemic corticosteroids (≤200 mg prednisone equivalents) compared to those prescribed high-dose therapy 4.
• The optimal dose and duration of systemic corticosteroid therapy in COPD exacerbations are still unknown and require further research 2, 3, 5.
• Some studies suggest that the additional therapeutic benefit of corticosteroids appears to be most apparent in the first 3 to 5 days of treatment 5.
• A randomized, double-blind, non-inferiority study (The RECUT-trial) is currently investigating whether a 3-day treatment with orally administered corticosteroids is non-inferior to a 5-day treatment in acute exacerbations of COPD in a primary-care setting 5.