WHAT'S NEW?: Now we know: 5 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 >5 days.3 This trial clearly demonstrated that 40 mg prednisone for 5 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 5-day regimen may be appropriate. For those who have failed prior attempts at short-course treatment, however, a 14-day course of treatment may be more advisable. That said, no guidelines are available to help us determine which of those who were previously treated with a longer regimen may fail on the shorter course of treatment.
Acknowledgement
The PURLs Surveillance System is supported in part by Grant Number UL 1RR 024999 from the National Center for Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
