From the Guidelines
For an adult experiencing a COPD exacerbation, the recommended oral prednisolone dose is 40 mg once daily for 5 days, as this dose has been shown to shorten recovery time, improve FEV1, and reduce the risk of early relapse and treatment failure 1. This short course of systemic corticosteroids helps reduce inflammation in the airways, decreases mucus production, and improves airflow, leading to faster symptom resolution. The 5-day duration is as effective as longer courses while minimizing side effects such as hyperglycemia, mood changes, insomnia, and increased infection risk, as noted in the global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report 1. Key points to consider when taking prednisolone for COPD exacerbation include:
- Take the medication in the morning with food to reduce stomach irritation and minimize sleep disturbances.
- No tapering is required for this short course.
- While taking prednisolone, continue your regular COPD medications including bronchodilators.
- If you have diabetes, monitor your blood glucose more frequently as prednisolone can raise blood sugar levels.
- Seek medical attention if symptoms worsen despite treatment or if you experience severe side effects. This treatment should be part of a comprehensive approach that may include antibiotics if bacterial infection is suspected, increased bronchodilator therapy, and oxygen supplementation if needed, as outlined in the 2017 report 1.
From the FDA Drug Label
The initial dose of prednisolone sodium phosphate oral solution, (15 mg prednisolone base) may vary from 1. 67 mL to 20 mL (5 to 60 mg prednisolone base) per day depending on the specific disease entity being treated. IT SHOULD BE EMPHASIZED THAT DOSAGE REQUIREMENTS ARE VARIABLE AND MUST BE INDIVIDUALIZED ON THE BASIS OF THE DISEASE UNDER TREATMENT AND THE RESPONSE OF THE PATIENT
The FDA drug label does not provide a specific oral dose of prednisolone for adult exacerbation of COPD.
- The dose may vary from 5 to 60 mg per day depending on the disease entity being treated.
- Individualization of the dose is required based on the disease and patient response. 2
From the Research
Oral Prednisolone Dose for Adult Exacerbation COPD
- The recommended oral dose of prednisolone for adult exacerbation of COPD is 30-40 mg per day for 5-14 days 3, 4, 5.
- A study found that 5 days of oral corticosteroids is likely to be sufficient for treatment of adults with acute exacerbations of COPD, and shorter courses of systemic corticosteroids (of around 5 days) may not lead to worse outcomes than longer courses (10-14 days) 3.
- Another study suggested that blood eosinophil-directed oral prednisolone therapy at the time of an acute exacerbation of COPD is non-inferior to standard care and can be used to safely reduce systemic glucocorticoid use in clinical practice 4.
- The use of guideline-recommended systemic corticosteroid and antibiotic therapy is recommended for hospitalized patients with COPD exacerbation, with a standard dose of prednisolone being ≤200 mg prednisone equivalents for the exacerbation course 6.
- A study found no difference in the effectiveness of adding antibiotics to prednisolone for COPD exacerbations of moderate severity and with intermediate probability of bacterial infection 7.
- Oral prednisolone was found to be not inferior to IV prednisolone in the treatment of COPD exacerbations, with similar treatment failure rates and improvements in spirometry and health-related quality of life 5.