Controlled trial of oral prednisone in outpatients with acute COPD exacerbation.

Abstract

Corticosteroids are often used in the outpatient treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD). To date, there are few data documenting the benefit of this practice. The objective of this randomized, double-blind, placebo-controlled trial was to assess the efficacy of corticosteroids in the outpatient treatment of COPD exacerbations. Twenty-seven patients presenting with acute COPD exacerbation were studied. In addition to continuing their previous medications and increasing their use of beta-agonists, patients were randomized to receive a 9-d tapering dose of either oral prednisone or placebo. Treatment with prednisone rather than placebo resulted in a more rapid improvement in arterial PO2 (PaO2) (1.12 mm Hg/d versus -0.03 mm Hg/day; p = 0.002), alveolar-arterial oxygen gradient (A-aDO2) (-1.16 mm Hg/d versus -0.03 mm Hg/day; p = 0.04), FEV1 (0.05 L/d versus 0.00 L/d; p = 0.006), and peak expiratory flow (PEF) (0.15 L/s/d versus 0.04 L/s/d; p = 0.009). Prednisone also resulted in fewer treatment failures (p = 0.002) and in a trend toward more rapid improvement in dyspnea scale scores. Outpatient treatment of acute COPD exacerbation with prednisone accelerates recovery of PaO2, A-aDO2, FEV1, and PEF, reduces the treatment failure rate, and improves subjective dyspnea.

Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids

“…Systemic glucocorticoids are frequently prescribed for exacerbations of the disease and have been shown to be effective in improving FEV1 [5], but even when given for exacerbations, the beneficial effects of systemic steroids appear to be limited to the first two weeks only [6].…”

Chronic obstructive pulmonary disease pathways as a tool to improve appropriateness in Internal Medicine Departments

“…The inhaled bronchodilator therapy for 7-10 days is always associated with systemic corticosteroid therapy, which has been shown to improve lung function [forced expiratory volume in the first second (FEV1)] and arterial hypoxemia, [30][31][32][33] reducing risk of early relapse, treatment failure, and length of hospital stay. 30,31,34 Recently have been recommended shorter cycles of systemic corticosteroid therapy (5 days) 9 compared to traditional 7-14 days.…”

Pathogen-directed Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

“…The median length of stay was also shorter in the steroid-treated group. In a study of 27 outpatients with an AE-COPD, Thompson and colleagues randomized patients to treatment with 9 days of prednisone (60 mg for 3 d, 40 mg for 3 d, and 20 mg for 3 d) or placebo (105). Patients treated with prednisone exhibited a faster and greater improvement in oxygenation and FEV 1 , while experiencing fewer treatment failures (0 vs. 57%, P 5 0.002).…”