From the Guidelines
Role of Corticosteroids in COPD Exacerbations
Corticosteroids are a crucial component in the management of Chronic Obstructive Pulmonary Disease (COPD) exacerbations, with systemic corticosteroids like prednisone 40mg daily being a recommended treatment [ 1, 1].
- A typical treatment duration is 5-7 days, although longer courses may be necessary in some cases, depending on patient response and severity of symptoms.
- Methylprednisolone 32mg daily is an alternative option, and the choice of medication and duration should be individualized based on patient factors [ 1, 1].
Key Considerations
- The use of intravenous corticosteroids may not offer significant benefits over oral corticosteroids in hospitalized patients with severe COPD exacerbations, and may be associated with a higher risk of adverse events [ 1].
- Systemic corticosteroids should not be used solely for the purpose of preventing hospitalization due to subsequent acute exacerbations of COPD beyond the first 30 days following the initial acute exacerbation 1.
- The benefits of systemic corticosteroids in treating acute exacerbations of COPD outweigh the risks of short-term use, which include hyperglycemia, weight gain, and insomnia 1.
From the Research
Role of Corticosteroids in Managing COPD Exacerbations
- Corticosteroids are commonly used to treat acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD) 2, 3, 4, 5, 6
- The use of systemic corticosteroids in COPD exacerbations is recommended by consensus guidelines, but clinical data are conflicting and inconsistent 5
- Studies have shown that systemic corticosteroids can improve airflow limitations, decrease treatment failure rates, decrease the risk of relapse, and may improve symptoms and decrease the length of hospital stay 2, 3, 5, 6
Duration of Corticosteroid Therapy
- Current guidelines recommend that patients with acute exacerbations of COPD should be treated with systemic corticosteroid for seven to 14 days 2, 3, 4
- However, studies have suggested that shorter courses of systemic corticosteroids (of around five days) may be sufficient for treatment of adults with acute exacerbations of COPD, and may lead to fewer adverse effects 2, 3
- The optimal duration of corticosteroid therapy is not known, but it should not extend longer than 2 weeks 6
Adverse Effects of Corticosteroids
- The use of systemic corticosteroids is associated with adverse effects such as osteoporosis, hyperglycaemia, and muscle weakness 2, 3, 4, 5, 6
- Hyperglycemia is the most common adverse event, but secondary infections, mental disturbances, and myopathies may also occur 6
- The lowest dose and shortest duration of corticosteroid therapy that will provide therapeutic benefit should be chosen to minimize the risk of adverse effects 5