Short-term vs Conventional Glucocorticoid Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Abstract

CUTE EXACERBATIONS OF chronic obstructive pulmonary disease (COPD) are a risk factor for disease deterioration, 1 and patients with frequent exacerbations have increased mortality. 2 In the general practitioner-based Swiss COPD cohort, approximately 23% to 25% of patients with COPD experienced exacerbations requiring pharmacological treatment within 1 year. 3,4 International guidelines and systematic reviews advocate systemic glucocorticoid therapy in the management of acute exacerbations of COPD (eg, 30-40 mg of oral prednisolone for 10-14 days). 5-7 Randomized clinical Author Affiliations are listed at the end of this article.

Lung microbiome dynamics in COPD exacerbations

“…Similar changes in the lung microbiome after these treatments were observed in a smaller study of 12 COPD subjects [8]. In support of reports on the limited efficacy and greater side-effects of steroids [25,26] our results suggest that steroids alone could affect the lung microbiome and underscore the importance of patient stratification approaches, such as blood eosinophil-guided prednisolone therapy [13], toward more precise drug management strategies.…”

“…This was followed by a decrease in Streptococcus (3.8%, adj. p=0.58 using paired t-test) and an increase in 25 Haemophilus (3.0%, adj. p=0.57 using paired t-test).…”

Ein Antibiotikum gehört bei COPD nicht zur Standardtherapie

“…Dann ist auch kein Ausschleichen nötig. Diese niedrige Dosis erwies sich auch bei intensivmedizinischen Bedingungen im Hinblick auf die Endpunkte "Verweildauer im Krankenhaus /Intensivstation" und die Nebenwirkungsrate der hochdosierten Prednisontherapie als überlegen [6,7].…”

The impact of pharmacy mediated conversion from intravenous to oral corticosteroids in patients with an exacerbation of chronic obstructive pulmonary disease

“…Based on current literature, the use of oral corticosteroids in patients with COPD exacerbations is as effective as IV administration, and would be preferred in cases where patients can safely absorb oral medications. Low dose oral corticosteroids are not associated with worse outcomes than high dose IV treatment, and the short course treatment of systemic corticosteroids is not inferior to long course treatment [10][11][12][13]. Thus, the treatment with oral corticosteroids for a short period of time seems to be a reasonable approach in treating patients with an acute exacerbation of COPD.…”