Steroids for Acute COPD—But for How Long?

WHAT’S NEW?

Now we know: five days is enough

While randomized trials have found that glucocorticoids improve COPD symptoms, the optimal treatment dose and duration were not known. Indeed, current guidelines recommend treatment for more than five days.³ This trial clearly demonstrated that 40-mg prednisone for five days is at least as good as a 14-day treatment course. Furthermore, it is un­necessary to taper the short-course therapy, which simplifies the regimen.

CAVEATS

Will the results apply to those less severely ill?

More than 80% of patients with acute COPD exacerbations can be managed in an outpatient setting.³ However, participants in this trial were hospitalized for a median of 8.5 days, and most had severe or very severe COPD—and thus, were not fully representative of COPD patients typically seen in an outpatient practice. Yet patients with less severe disease should be at least as likely to ­respond to short-course steroids as those whose COPD is more ­severe.

It is important to note that participants in this study all received optimal guideline-based therapies during hospitalization, which may be difficult to achieve for some patients treated in an outpatient setting. Finally, treatment adherence observed during the hospitalization period in this trial is unlikely to be replicated in the outpatient setting.

CHALLENGES TO IMPLEMENTATION

Identifying patients who need steroids for a longer duration

For patients with new COPD exacerbations or those successfully treated using short-course therapy in the past, a five-day regimen may be appropriate. For those in whom prior attempts at short-course treatment have failed, however, a 14-day course of treatment may be more advisable. That said, no guidelines are available to help us determine which patients previously treated with a longer regimen will find the shorter course of treatment unsuccessful.

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