From the Guidelines
The recommended steroid taper schedule for Chronic Obstructive Pulmonary Disease (COPD) is 40 mg prednisone per day for 5 days.
Key Points
- This dosage is supported by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1 and the European Respiratory Society/American Thoracic Society guideline 1.
- Oral 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.
- The effectiveness of oral corticosteroids may vary depending on the patient's blood eosinophil levels, with patients having higher levels potentially responding better to treatment 1.
- Some studies suggest that shorter courses of systemic corticosteroid treatment (e.g., 3-7 days) may be as effective as longer courses in hospitalized patients with exacerbations of COPD, but more research is needed to confirm this in ambulatory patients 1.
- The benefits of oral corticosteroids likely outweigh the adverse effects, burdens, and costs, but more research is needed to fully understand the effects of treatment on different patient populations 1.
From the Research
Recommended Steroid Taper Schedule for COPD
The recommended steroid taper schedule for Chronic Obstructive Pulmonary Disease (COPD) is as follows:
- Current guidelines recommend that patients with acute exacerbations of COPD should be treated with systemic corticosteroid for seven to 14 days 2, 3, 4.
- However, studies have shown that shorter treatment courses of around five days may be sufficient for treatment of adults with acute exacerbations of COPD, with no significant difference in risk of treatment failure or relapse compared to longer courses 2, 3, 5.
- 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 6.
- Tapering of systemic corticosteroid regimens 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 4.
Key Findings
- No significant difference in risk of treatment failure or relapse between short-duration and longer-duration systemic corticosteroid treatment 2, 3, 5.
- Shorter treatment courses may reduce adverse effects such as osteoporosis, hyperglycaemia, and muscle weakness 2, 3, 4.
- Low-dose corticosteroid regimens such as prednisone 40 mg orally once/day for 10-14 days are supported by safety and efficacy data 4.
- 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 6.