From the Guidelines
Recommended Steroid Taper Regimen for COPD Exacerbation
The recommended steroid taper regimen after a Chronic Obstructive Pulmonary Disease (COPD) exacerbation is Prednisone 30-40mg orally once daily for 5 days 1.
Details of the Regimen
- The dose of 30-40mg per day for 5 days is supported by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1.
- A shorter duration of systemic corticosteroid treatment, such as 5 days, may be as effective as longer courses in hospitalized patients with exacerbations of COPD 1.
- The total duration of the steroid taper should not exceed 14 days.
- Some studies suggest that patients with an elevated blood eosinophil count (⩾2%) may respond better to oral corticosteroids than those with a low blood eosinophil count 1.
- The benefits of oral corticosteroids probably outweigh the adverse effects, burdens, and costs, but the confidence in the accuracy of the estimated effects is very low 1.
Key Points
- Prednisone dose: 30-40mg orally once daily for 5 days
- Total duration: not to exceed 14 days
- Blood eosinophil count: may influence response to oral corticosteroids
- Benefits and risks: benefits probably outweigh adverse effects, but with low confidence in estimated effects 1
From the Research
Recommended Steroid Taper Regimen
The recommended steroid taper regimen after a Chronic Obstructive Pulmonary Disease (COPD) exacerbation is as follows:
- Current guidelines recommend that patients with acute exacerbations of COPD should be treated with systemic corticosteroid for seven to 14 days 2
- A study found that five days of oral corticosteroids is likely to be sufficient for treatment of adults with acute exacerbations of COPD, and this review suggests that the likelihood is low that shorter courses of systemic corticosteroids (of around five days) lead to worse outcomes than are seen with longer (10 to 14 days) courses 2
- Another study suggests that low-dose corticosteroid regimens such as prednisone 40 mg orally once/day for 10-14 days in most patients with an acute exacerbation of COPD is supported by safety and efficacy data 3
- A pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials found that 2-5 day regimens for treating COPD exacerbations were associated with shorter hospital stays and fewer days alive and out of hospital within 14 days, with no apparent 6-month benefit regarding death or admission to ICU in COPD patients 4
Key Considerations
- The choice of steroid taper regimen should be individualized based on the patient's specific needs and circumstances
- The use of systemic corticosteroids in patients with acute exacerbations of COPD is associated with several adverse effects, including osteoporosis, hyperglycaemia, and muscle weakness 2, 3
- Eosinophil-guided therapy has been shown to reduce the duration of systemic corticosteroid exposure in patients admitted to hospital with acute exacerbations of COPD, although larger studies are needed to determine the full safety profile of this strategy 5