Severe exacerbations of COPD are independently associated with mortality,2 regardless of baseline severity. Guidelines and systematic reviews highlight the importance of using oral glucocorticoids in the management of acute COPD exacerbations, as the drugs have been found to shorten recovery time and length of hospital stay, improve lung function, and reduce the risk for early relapse and treatment failure.3-5 What is not clear is how long the course of oral steroids should be.
What we know (and don’t know) about duration
Data supporting a 14-day course of steroids versus a longer (eight-week) duration come from the Systemic Corticosteroids in COPD Exacerbations trial.6 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria suggest a 10- to 14-day regimen (30 to 40 mg/d) but acknowledge that there is a lack of data from clinical and observational studies to support this recommendation.3 A recent Cochrane review compared a short course of treatment (three to seven days) with a longer regimen (10 to 15 days) and found that the evidence to support a clinical practice change was inconclusive.5
The study detailed in this PURL—a double-blind RCT comparing five-day with 14-day oral steroid treatment in patients hospitalized for acute COPD exacerbation—had more definitive results.1
Continue reading for the study summary...