From the Guidelines
Recommended Oral Dose of Prednisone for COPD Exacerbation
The recommended oral dose of prednisone for a Chronic Obstructive Pulmonary Disease (COPD) exacerbation is 40 milligrams (mg) per day for 5 days 1. This short-course regimen of systemic corticosteroids has been shown to be effective in reducing symptoms, improving lung function, and decreasing the risk of relapse.
- The dose of 40 mg per day is based on evidence from studies that demonstrate its efficacy in managing COPD exacerbations, including improving FEV1, oxygenation, and reducing the risk of early relapse and treatment failure 1.
- Alternatively, a dose of 40 mg orally per day for 5 days can be considered, as it is equally effective to intravenous administration and may be followed by a tapering regimen, although this is not typically necessary for most patients 1.
- It's worth noting that the effectiveness of glucocorticoids may be less in patients with lower blood eosinophil levels 1, but the recommended dose remains the same.
- The European Respiratory Society/American Thoracic Society guideline also supports the use of oral corticosteroids in COPD exacerbations, with a recommended dose of 30-40 mg prednisone per day for 5 days 1.
From the Research
Oral Dose of Prednisone for COPD Exacerbation
- The optimal starting dose of corticosteroids is not known, but the duration of treatment should not extend longer than 2 weeks 2
- Outpatient treatment with oral prednisone offers a small advantage over placebo in treating patients who are discharged from the emergency department with an exacerbation of COPD, with a dose of 40 mg of oral prednisone once daily for 10 days 3
- A short-term (5 days) systemic glucocorticoid treatment with 40 mg of prednisone daily is noninferior to conventional (14 days) treatment in clinical outcome and decreases the exposure to steroids 4
Duration of Treatment
- The duration of treatment should not extend longer than 2 weeks 2
- A 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up 4
- Shorter treatment could reduce adverse effects, and there is no evidence that the benefit of corticosteroid treatment is maintained after 72 hours 5
Adverse Effects
- Hyperglycemia is the most common adverse event, but secondary infections, mental disturbances, and myopathies may also occur 2
- Treatment with oral or parenteral corticosteroids increases the risk of an adverse drug reaction 5
- There was no difference between groups in treatment-associated adverse reactions, including hyperglycemia and hypertension 4