From the Guidelines
For a COPD exacerbation, the recommended oral prednisone dose is 40 mg once daily for 5 days. This short-course regimen is as effective as longer courses while minimizing steroid-related side effects, as supported by the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1. Some clinicians may prescribe alternative regimens such as 30-60 mg daily for 5-14 days, but the 5-day course at 40 mg is now considered standard practice. The medication should be taken in the morning with food to reduce gastrointestinal irritation. No tapering is required for this short-duration therapy. Prednisone works by reducing inflammation in the airways, decreasing mucus production, and improving airflow.
Key points to consider when prescribing oral prednisone for COPD exacerbation include:
- Monitoring for potential side effects, including elevated blood glucose (particularly in diabetics), mood changes, insomnia, and fluid retention 1
- Concurrent use of bronchodilator therapy and appropriate antibiotics (if bacterial infection is suspected) as part of comprehensive COPD exacerbation management 1
- The benefits of systemic corticosteroids in reducing recurrent exacerbations in the first 30 days following an initial acute exacerbation of COPD, while considering the risks associated with short-term use 1
- The lack of evidence supporting the use of long-term corticosteroids to reduce acute exacerbations of COPD, and the associated risks of hyperglycemia, weight gain, infection, osteoporosis, and adrenal suppression 1
It is essential to note that the use of systemic corticosteroids to treat an acute exacerbation has not been shown to reduce acute exacerbations beyond the 30-day window, as stated in the 2015 American College of Chest Physicians and Canadian Thoracic Society guideline 1. If symptoms do not improve or worsen after 3 days of treatment, the patient should seek medical attention for reassessment.
From the Research
Dose of Oral Prednisone for COPD Exacerbation
- The recommended dose of oral prednisone for COPD exacerbation varies, but clinical practice guidelines suggest 40-60 mg of prednisone equivalent for 10-14 days 2.
- A study published in 2022 found that recent literature and guidelines support treatment of severe acute exacerbation of COPD with prednisone 40 mg (or equivalent) for 5 days 3.
- Another study from 1996 used a 9-day tapering dose of oral prednisone, starting with a higher dose, but the exact dose was not specified 4.
- A randomized clinical trial published in 2013 compared 5-day and 14-day treatment with 40 mg of prednisone daily and found that the 5-day treatment was noninferior to the 14-day treatment 5.
- A review article from 2006 suggested that a low-dose corticosteroid regimen, such as prednisone 40 mg orally once/day for 10-14 days, is safe and effective for most patients with an acute exacerbation of COPD 6.
Duration of Treatment
- The duration of treatment with oral prednisone for COPD exacerbation also varies, but studies suggest that 5-14 days is a common range 2, 3, 5.
- A study published in 2013 found that 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up 5.
Key Findings
- The use of oral prednisone for COPD exacerbation can improve symptoms and reduce the risk of treatment failure 2, 4.
- Higher dose corticosteroid regimens may place patients at increased short-term and long-term risk without additional clinical benefit 6.
- Tapering of systemic corticosteroid regimens is unnecessary in most circumstances, and low-dose, short-course regimens are generally safe and effective 6.