What are the first-line glucocorticoids (corticosteroids) for acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD)?

First-Line Glucocorticoids for Acute Exacerbation of COPD

Oral prednisone at a dose of 40 mg daily for 5 days is the recommended first-line glucocorticoid treatment for acute exacerbations of COPD. 1

Systemic Glucocorticoid Therapy: Evidence and Recommendations

Preferred Agent and Dosing

• Prednisone is the preferred oral glucocorticoid for COPD exacerbations
• Recommended regimen: 40 mg oral prednisone daily for 5 days 1
• Oral prednisolone is an equivalent alternative (30-40 mg daily for 5 days) 2
• Oral administration is equally effective to intravenous administration 1

Duration of Therapy

• Short-duration therapy (5 days) is as effective as conventional longer-duration therapy (10-14 days) 3
• Treatment should not be extended beyond 5-7 days 1, 2
• Longer courses do not provide additional benefits but increase the risk of adverse effects 3

Clinical Benefits

Systemic glucocorticoids in COPD exacerbations:

• Shorten recovery time
• Improve lung function (FEV1)
• Improve oxygenation
• Reduce risk of early relapse and treatment failure
• Reduce length of hospitalization 1
• Reduce the risk of treatment failure within 30 days 4

Special Considerations

Route of Administration

• Oral therapy is preferred and equally effective to intravenous administration 1
• Intravenous administration should be reserved for patients unable to take oral medications 1

Patient-Specific Factors

• Glucocorticoids may be less efficacious in patients with lower blood eosinophil levels 1
• For patients with uncontrolled diabetes requiring corticosteroids, close glucose monitoring and temporary adjustment of diabetes medications are necessary 2

Potential Adverse Effects

• Short-term adverse effects include:
  • Hyperglycemia
  • Weight gain
  • Insomnia
  • Fluid retention
  • Increased risk of infection 2, 4
• The risk of adverse effects increases with longer duration of therapy 4

Monitoring During Treatment

• Blood glucose monitoring, especially in patients with diabetes
• Blood pressure monitoring
• Mental status assessment
• Electrolyte monitoring if on diuretics 2

Important Caveats

• Systemic glucocorticoids should only be used for the acute exacerbation and not continued long-term 1
• The benefits of short-term systemic glucocorticoids outweigh the risks in acute COPD exacerbations 1
• Methylxanthines (e.g., theophylline) are not recommended due to increased side effect profiles 1

In conclusion, a 5-day course of oral prednisone at 40 mg daily is the first-line glucocorticoid treatment for acute exacerbations of COPD, providing significant clinical benefits while minimizing the risk of adverse effects associated with longer treatment durations.