Short- vs. Longer-Duration Corticosteroid Tx for COPD Exacerbations

For patients with chronic obstructive pulmonary disease (COPD), exacerbations may be brought on by both infectious (bacterial, viral pathogens) and non-infectious (air pollution, other environmental conditions) causes.  Currently, COPD guidelines recommend that patients with acute exacerbations be treated with systemic corticosteroids for 7–14 days, however, an updated review published in The Cochrane Library suggests that corticosteroid treatment of a shorter duration (≤7 days) may be as effective as conventional longer-duration (>7 days) therapy.

Researchers examined 8 clinical trials involving 582 patients with COPD (classified as either severe or very severe) who met inclusion criteria; equivalent daily doses of corticosteroid treatment were given either for a short-duration (3–7 days) or for a longer-duration (10–15 days).  Study results included the following:

• No difference in risk of treatment failure between short and longer duration therapy (4 studies)
• No difference in risk of relapse between short and longer duration therapy
• No difference in time to next COPD exacerbation in one study comparing 5-day and 14-day treatment
• No difference in likelihood of adverse event between short and longer duration therapy (5 studies)
• No difference in lung function at end of treatment or length of hospital stay between short and longer duration therapy

The authors conclude that for adult COPD patients with acute exacerbations, 5 days of oral corticosteroids may be sufficient for treatment and that the likelihood of shorter corticosteroid courses leading to worse outcomes is low. Since the study did not include patients with mild or moderate disease, more research will need to be done to see how short-duration treatment compares to longer-duration treatment in this patient population.