Prednisolone in Acute Exacerbation of COPD (AECOPD)
Yes, prednisolone is strongly indicated in acute exacerbations of COPD and should be administered promptly to improve outcomes. 1, 2
Dosage and Duration
- The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends 30-40 mg prednisolone daily for 5 days for COPD exacerbations 1
- Common practice is to use a 7-14 day course of systemic corticosteroids (prednisolone 30 mg/day) 3
- Shorter courses (5-7 days) are as effective as longer courses while minimizing adverse effects 1, 4
- If oral administration is not possible, intravenous hydrocortisone (100 mg) can be used 3
Benefits of Prednisolone in AECOPD
- Accelerates recovery of lung function (FEV1 and peak expiratory flow) 5
- Improves arterial oxygenation (PaO2) and reduces alveolar-arterial oxygen gradient 5
- Reduces treatment failure rates and risk of relapse 4
- May decrease length of hospital stay 4
- Prevents hospitalization for subsequent exacerbations in the first 30 days following the initial exacerbation 3, 1
Route of Administration
- Oral administration is preferred over intravenous when possible 1, 6
- Oral prednisolone is non-inferior to intravenous administration with similar clinical outcomes and fewer adverse effects 6
- A study of hospitalized COPD patients showed no difference in treatment failure rates between oral and IV prednisolone (56.3% vs 61.7%) 6
Patient Selection Considerations
- Blood eosinophil count may predict response to corticosteroids - patients with count ≥2% show better response 1, 7
- Recent evidence suggests that blood eosinophil-guided therapy (giving prednisolone only when eosinophil count ≥2%) is non-inferior to standard care and can safely reduce systemic corticosteroid use 7
Important Cautions
- Systemic corticosteroids should not be given for the sole purpose of preventing hospitalization beyond the first 30 days following the initial exacerbation 3, 1
- No evidence supports long-term corticosteroid use to reduce AECOPD, and the risks outweigh benefits 3, 1
- Short-term adverse effects include hyperglycemia, weight gain, and insomnia 3, 1
- Long-term use carries risks of infection, osteoporosis, and adrenal suppression 3, 1
Alternative Corticosteroid Options
- Inhaled budesonide (2 mg three times daily) has shown similar clinical outcomes to systemic methylprednisolone (40 mg/day) with fewer adverse effects in some studies 8
- Consider inhaled corticosteroids as an alternative in patients at high risk for systemic corticosteroid complications 8
FDA-Approved Indication
- Prednisolone is FDA-approved for "acute exacerbations of chronic obstructive pulmonary disease (COPD)" 2