What is the dose of corticosteroid (steroid) in Chronic Obstructive Pulmonary Disease (COPD) and asthma exacerbation?

From the Guidelines

For COPD exacerbations, prednisone 40mg daily for 5 days is the recommended steroid regimen, as it shortens recovery time, improves lung function, and reduces the risk of early relapse and hospitalization 1. This recommendation is based on the most recent and highest quality studies, including the 2017 European Respiratory Society/American Thoracic Society guideline and the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document. Some key points to consider when administering corticosteroids for COPD exacerbations include:

• Early steroid administration is crucial to reduce inflammation, decrease mucus production, and enhance bronchodilator responsiveness
• Oral prednisolone is equally effective to intravenous administration 1
• Glucocorticoids may be less efficacious in patients with lower blood eosinophil levels 1
• Patients should be monitored for side effects, including hyperglycemia, mood changes, and insomnia, though these are less common with short courses
• For patients with frequent exacerbations, consider maintenance inhaled corticosteroids after the acute episode resolves For asthma exacerbations, the recommended steroid regimen is typically prednisone 40-60mg daily for 5-7 days for adults, with no taper needed for these short courses 1. It's also important to note that:
• Children with asthma exacerbations should receive prednisolone 1-2mg/kg/day (maximum 60mg) for 3-5 days
• Steroids should be started promptly in the emergency department or upon recognition of the exacerbation
• Patients should be instructed to complete the full course even if symptoms improve quickly Overall, the use of corticosteroids in COPD and asthma exacerbations is a crucial component of treatment, and prednisone 40mg daily for 5 days is the recommended regimen for COPD exacerbations, based on the strongest and most recent evidence 1.

From the FDA Drug Label

The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses

• The dose of corticosteroid (steroid) in Chronic Obstructive Pulmonary Disease (COPD) is not explicitly stated in the provided drug label.
• For asthma exacerbation, the recommended dose is 1-2 mg/kg/day in single or divided doses, as per the National Heart, Lung, and Blood Institute (NHLBI) guidelines 2.
• The treatment duration is usually 3 to 10 days, or until symptoms resolve or a peak expiratory flow rate of 80% of the patient's personal best is achieved.

From the Research

Dose of Corticosteroid in COPD and Asthma Exacerbation

• The optimal dose of corticosteroid for treating acute exacerbations of chronic obstructive pulmonary disease (COPD) is still a topic of debate 3, 4, 5, 6, 7.
• Studies have shown that systemic corticosteroids can reduce the risk of treatment failure and relapse in COPD patients, with a significant improvement in lung function and symptoms 3, 4.
• A meta-analysis found that the use of systemic corticosteroids was associated with a significant reduction in treatment failure rate and improvement in forced expiratory volume in 1 s (FEV1) 6.
• The REDUCE randomized clinical trial found that a 5-day treatment with systemic glucocorticoids was noninferior to a 14-day treatment in terms of reexacerbation within 6 months of follow-up, but significantly reduced glucocorticoid exposure 5.
• Another study found that the low-dose regimen (initial dose 30-80 mg/day prednisone equivalent) was proper for treating acute exacerbations of COPD, and that higher doses did not show superiority 6.
• A review of recent evidence suggested that higher-dose corticosteroids are not superior to treatment with lower-dose corticosteroids in patients with severe acute exacerbations of COPD, and that longer durations of systemic corticosteroid therapy do not improve clinical outcomes 7.

Key Findings

• Systemic corticosteroids can reduce treatment failure and relapse in COPD patients 3, 4, 5, 6.
• The optimal dose of corticosteroid is still unknown, but lower doses (30-80 mg/day prednisone equivalent) may be sufficient 6, 7.
• Shorter durations of systemic corticosteroid therapy (5 days) may be noninferior to longer durations (14 days) in terms of reexacerbation within 6 months of follow-up 5.
• The type of antibiotic used may not significantly impact patient outcomes, but macrolides, fluoroquinolones, and beta-lactams are all reasonable treatment options for severe acute exacerbations of COPD 7.