What is the role of corticosteroids (steroids) in the treatment of acute Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Corticosteroids play a crucial role in the treatment of acute Chronic Obstructive Pulmonary Disease (COPD) exacerbations, particularly in severe cases requiring hospitalization.

Key Points

• Systemic corticosteroids are recommended for the treatment of acute COPD exacerbations, especially in patients with severe symptoms 1.
• The use of oral corticosteroids for 9-14 days in outpatients with COPD exacerbations can improve lung function and reduce hospitalizations 1.
• High-dose intravenous corticosteroids may not have a higher efficacy than oral corticosteroids in hospitalized patients with severe exacerbations and can potentially be associated with a higher risk of adverse events 1.
• The benefits of oral corticosteroids likely outweigh the adverse effects, burdens, and costs, but more research is needed to confirm this 1.

Treatment Considerations

• The choice between oral and intravenous corticosteroids should be based on the severity of the exacerbation and the patient's ability to take oral medications.
• A course of oral corticosteroids, such as prednisolone 60 mg/day for 5-10 days, can be effective in treating acute COPD exacerbations 1.
• Patients with an elevated blood eosinophil count (≥2%) may respond better to oral corticosteroids than those with a low blood eosinophil count 1.
• Further research is needed to determine the optimal duration of systemic corticosteroid treatment and to identify phenotypic responders to oral corticosteroids 1.

From the Research

Role of Corticosteroids in Acute COPD Treatment

• Corticosteroids are a standard treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and have been shown to improve airflow, decrease treatment failure, and reduce hospital stay 2.
• The use of systemic corticosteroids in AECOPD has been associated with improved outcomes, including reduced risk of relapse and improved symptoms 2.
• Inhaled corticosteroids (ICS) may be used as an alternative to systemic corticosteroids, with similar clinical outcomes and reduced risk of side effects 3.

Comparison of Systemic and Inhaled Corticosteroids

• A study comparing nebulized budesonide and intravenous methylprednisolone found similar clinical outcomes, with reduced incidence of adverse events in the budesonide group 3.
• Another study found that long-term use of ICS reduced the rate of exacerbations and improved quality of life, but increased the risk of oropharyngeal candidiasis and pneumonia 4.

Guidelines and Recommendations

• Major guidelines recommend the use of systemic corticosteroids in the treatment of AECOPD, with the lowest effective dose and shortest duration of therapy considered 2.
• ICS-containing maintenance therapy should be reserved for patients with frequent or severe exacerbations and high blood eosinophils, or those with concomitant asthma 5.
• Prescription of ICS in patients not fulfilling guideline criteria may put patients at unnecessary risk of pneumonia and other long-term adverse events 5.

Dosing and Administration

• The optimal strategy for dosing and administration of corticosteroids in AECOPD continues to be debated, with low-dose oral corticosteroids considered as efficacious as high-dose, intravenous regimens 2.
• Recent data suggest that shorter durations of corticosteroid therapy may be as efficacious as traditional treatment durations 2.