From the Guidelines
For severe COPD exacerbations, oral prednisone 30-40mg daily for 5 days is the recommended steroid regimen, as it shortens recovery time, improves lung function and hypoxemia, and may reduce the risk of early relapse, treatment failure, and length of hospital stay. This recommendation is based on the 2014 Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1. The use of systemic corticosteroids in COPD exacerbations has been shown to be beneficial in reducing airway inflammation, decreasing mucus production, and improving bronchodilator responsiveness, which helps resolve the exacerbation more quickly.
Key points to consider in the management of severe COPD exacerbations include:
- Starting treatment promptly, ideally within 24-48 hours of symptom worsening
- Monitoring for potential side effects including hyperglycemia, mood changes, and insomnia, though these are less common with shorter courses
- Concurrent treatment with bronchodilators, antibiotics if indicated, and oxygen therapy is essential for comprehensive management of the exacerbation
- No need for tapering with these short courses, as they are as effective as longer courses while minimizing side effects, as suggested by the European Respiratory Society/American Thoracic Society guideline 1.
It is essential to note that the management of COPD exacerbations should be individualized, taking into account the patient's unique clinical circumstances, and that these guidelines should not be viewed as dictates, but rather as a basis for rational decisions in the treatment of COPD exacerbations 1.
From the Research
Steroids Dose for Severe COPD Exacerbation
- The recommended dose of steroids for severe COPD exacerbation is prednisone 40 mg (or equivalent) for 5 days, as supported by recent literature and guidelines 2, 3.
- A study published in the Journal of Pharmacy Practice found that only 2.1% of patients received both appropriate corticosteroid dose and duration, highlighting the need for improved prescribing practices 2.
- The REDUCE randomized clinical trial demonstrated that 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up, and significantly reduced glucocorticoid exposure 3.
- A meta-analysis published in Respiratory Care found that low-dose systemic corticosteroids (initial dose ≤ 40 mg prednisone equivalent/d) were sufficient and safer for treating patients with COPD exacerbation, and were noninferior to higher doses of SCS in improving FEV1 and reducing the risk of treatment failure 4.
- Another study published in Pharmacotherapy suggested that low-dose corticosteroid regimens, such as prednisone 40 mg orally once/day for 10-14 days, are supported by safety and efficacy data for most patients with an acute exacerbation of COPD 5.
Key Findings
- Prednisone 40 mg (or equivalent) for 5 days is the recommended dose for severe COPD exacerbation 2, 3.
- Low-dose systemic corticosteroids are sufficient and safer for treating patients with COPD exacerbation 4.
- The optimal corticosteroid regimen for the management of an acute exacerbation of COPD remains controversial, with varying doses and durations used in different studies 5.