From the Guidelines
Corticosteroid use is recommended in COPD exacerbations.
Key Points
- Systemic corticosteroids improve lung function, oxygenation, and shorten recovery time and hospitalization duration in COPD exacerbations 1.
- The recommended duration of corticosteroid therapy is 5-7 days 1, with a dose of 30-40 mg prednisone per day 1.
- Both oral and intravenous corticosteroids can be used, with no significant difference in treatment failure, mortality, or hospital readmissions between the two routes of administration 1.
- The use of systemic corticosteroids is suggested to prevent hospitalization for subsequent acute exacerbations of COPD in the first 30 days following the initial exacerbation 1.
- However, the use of systemic corticosteroids beyond the first 30 days is not recommended due to the risks of hyperglycemia, weight gain, infection, osteoporosis, and adrenal suppression outweighing any potential benefits 1.
Adverse Effects
- The use of corticosteroids can be associated with mild adverse effects, such as hyperglycemia, weight gain, and insomnia, but these are generally considered to be outweighed by the benefits of treatment 1.
- High-dose intravenous corticosteroids may be associated with a higher risk of adverse events compared to oral corticosteroids, although this may be due to the higher dose rather than the route of administration 1.
From the Research
Corticosteroid Use in COPD Exacerbation
- The use of systemic corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD) has been studied extensively 2, 3, 4, 5, 6.
- Studies have shown that short courses of systemic corticosteroids can improve spirometric outcomes and clinical outcomes in patients with COPD exacerbations 2, 3.
- The literature suggests that hospitalized patients may benefit from higher initial doses of systemic corticosteroids, followed by an oral taper dose 4.
- Inhaled corticosteroids (ICSs) have been shown to be effective in the treatment of COPD exacerbations and may be an alternative to systemic corticosteroids (SCs) 5.
- The optimal duration and dosing of systemic corticosteroids for COPD exacerbations remains unclear, with some studies suggesting that short duration treatment (less than 14 days) may be effective 6.
Benefits of Corticosteroid Use
- Improvement in spirometric measures, such as forced expiratory volume in 1 second (FEV1) 2, 3.
- Decrease in treatment failure rates and risk of relapse 4.
- Improvement in symptoms and decrease in length of hospital stay 4.
- Increase in lung function, as measured by FEV1%pred and blood gas analyses 5.
Risks and Considerations
- Increased risk of adverse drug reactions, such as hyperglycemia and infection 3, 6.
- Potential for prolonged use of systemic corticosteroids to lead to adverse effects, such as osteoporosis and cataracts 4.
- Need for careful consideration of the optimal duration and dosing of systemic corticosteroids to balance efficacy and safety 6.