From the Guidelines
A COPD patient with pneumonia should be started on 40mg of prednisone daily for 5 days, as recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy document 1. This dose is supported by evidence from the American Journal of Respiratory and Critical Care Medicine, which suggests that systemic glucocorticoids in COPD exacerbations shorten recovery time and improve FEV1, oxygenation, and reduce the risk of early relapse, treatment failure, and length of hospitalization 1. After the initial 5 days, the prednisone dose can be tapered down to minimize side effects and avoid adrenal suppression. Some key points to consider when prescribing prednisone to a COPD patient with pneumonia include:
- Taking the medication in the morning with food to minimize gastrointestinal side effects and sleep disturbances
- Monitoring blood glucose levels, especially in diabetic patients, as prednisone can cause hyperglycemia
- Completing the entire course as prescribed and not stopping abruptly, which could lead to adrenal crisis
- Being aware of potential side effects including mood changes, increased appetite, fluid retention, and elevated blood pressure during treatment It's also important to note that the European Respiratory Society/American Thoracic Society guideline recommends the use of oral corticosteroids in conjunction with other therapies in all patients admitted to hospital with an exacerbation of COPD and considered in patients in the community who have an exacerbation with a significant increase in breathlessness that interferes with daily activities 1. However, the most recent and highest quality study, the 2017 GOLD executive summary, recommends a dose of 40 mg prednisone per day for 5 days 1. Therefore, the recommended prednisone taper for a COPD patient with pneumonia is 40mg daily for 5 days, followed by a gradual taper. The tapering regimen can be adjusted based on individual patient response and clinical judgment.
From the Research
Prednisone Taper Down Example for a COPD Patient with Pneumonia
- The optimal corticosteroid regimen for the management of an acute exacerbation of chronic obstructive pulmonary disease (COPD) is still a topic of debate 2.
- A study comparing two systemic steroid regimens for the treatment of COPD exacerbations found that oral administration of methylprednisolone at a dose of 32 mg/day for seven days was as effective as and possibly safer than parenteral administration of higher doses 3.
- Another study suggested that low-dose corticosteroid regimens, such as prednisone 40 mg orally once/day for 10-14 days, may be sufficient for most patients with an acute exacerbation of COPD 2.
- A comparison of two corticosteroid regimens in acute exacerbation of COPD found that intravenous methylprednisolone followed by oral methylprednisolone produced greater improvement in forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) than intravenous hydrocortisone followed by oral prednisolone 4.
- Regarding pneumonia, inhaled corticosteroids have been linked with an increased risk of pneumonia in individuals with COPD, and the risk may vary depending on the type and dose of the inhaled corticosteroid 5, 6.
- A meta-analysis found that inhaled corticosteroid treatment was associated with an increased risk of pneumonia, and the risk was higher in certain subgroups, such as patients over 65 years old and those with a lower baseline forced expiratory volume in the first second of expiration (FEV1) 6.
Tapering Prednisone
- Tapering of systemic corticosteroid regimens is not always necessary, and the risk of hypothalamic-pituitary-adrenal-axis suppression is negligible when low-dose, short-course corticosteroid regimens are used 2.
- However, tapering may be considered in certain situations, such as when high-dose corticosteroids are used for an extended period.
- A common tapering regimen for prednisone is to reduce the dose by 5-10 mg every 3-5 days, but the optimal tapering schedule may vary depending on the individual patient and the specific clinical situation.