What is the recommended dosing frequency of hydrocortisone (corticosteroid) for COPD (Chronic Obstructive Pulmonary Disease) exacerbations, should it be given once daily (OD) or twice daily (BD)?

Hydrocortisone Dosing for COPD Exacerbations

For COPD exacerbations, oral corticosteroids once daily (OD) is the preferred dosing frequency over twice daily (BD) administration, as once-daily dosing provides equivalent efficacy with potentially fewer adverse effects. 1

Preferred Route and Dosing Frequency

• Oral corticosteroids are preferred over intravenous administration for COPD exacerbations when patients can tolerate oral medications 1, 2
• Once-daily (OD) administration of corticosteroids is the standard recommended dosing frequency for COPD exacerbations 1, 2
• The American Thoracic Society recommends that for patients unable to take oral corticosteroids, intravenous hydrocortisone 100 mg once daily is the recommended alternative to oral prednisolone 30 mg daily 1

Evidence Supporting Once Daily Dosing

• Multiple guidelines recommend once-daily dosing of systemic corticosteroids for COPD exacerbations, including:
  • The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends 30-40 mg prednisone daily for 5 days 2
  • The European Respiratory Society/American Thoracic Society (ERS/ATS) recommends short-course therapy with once-daily dosing 3, 2
• Studies comparing different corticosteroid regimens have shown that once-daily dosing is as effective as more frequent dosing schedules 4, 5
• The REDUCE trial demonstrated that 40 mg of prednisone once daily for 5 days was non-inferior to 14 days of treatment for preventing reexacerbations 4

Duration of Treatment

• Systemic corticosteroid therapy should be limited to 5-7 days to minimize adverse effects while maintaining efficacy 1, 6
• The American College of Chest Physicians suggests that the duration of systemic corticosteroid therapy should not extend longer than 5-7 days 1
• Longer courses of corticosteroids (>7 days) do not provide additional benefits but increase the risk of adverse effects 6, 4

Intravenous vs. Oral Administration

• Studies comparing intravenous versus oral corticosteroids found no significant differences in:
  • Treatment failure rates 3
  • Hospital readmissions 3
  • Length of hospital stay 3
• Intravenous administration may be associated with a higher risk of adverse effects compared to oral administration, including hyperglycemia and hypertension 1, 2
• Transition from intravenous to oral corticosteroids should occur as soon as the patient can tolerate oral medications 1

Adverse Effects and Monitoring

• Higher doses and twice-daily administration of corticosteroids may place patients at increased risk for adverse effects without additional clinical benefit 7, 5
• Common adverse effects of systemic corticosteroids include:
  • Hyperglycemia (more frequent with intravenous administration) 1, 5
  • Hypertension 1
  • Insomnia 3
  • Weight gain 3
• Monitor for clinical improvement in respiratory symptoms and potential adverse effects during treatment 2

Special Considerations

• Blood eosinophil count may predict response to corticosteroids - patients with blood eosinophil count ≥2% show better response to oral corticosteroids 2
• Patients with blood eosinophil count <2% may have less benefit from corticosteroid therapy 2
• After initial treatment, corticosteroids should be discontinued after the acute episode unless there is a definite indication for long-term treatment 1

In conclusion, once-daily (OD) administration of hydrocortisone is the preferred dosing frequency for COPD exacerbations based on current guidelines and evidence, providing equivalent efficacy to twice-daily (BD) dosing with potentially fewer adverse effects.