Should All Patients with COPD Exacerbations Receive Oral Steroids?

20 Jan 2024 • Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend managing chronic obstructive pulmonary disease (COPD) exacerbations with 40-mg prednisone for 5 days, plus oral antibiotics for patients with excessive cough and purulence.

But whether steroids help all patients or just those with eosinophilia is unclear.

  • U.K. researchers compared two approaches for COPD exacerbations: blood eosinophil–directed treatment (BET; i.e., 30-mg prednisolone for 14 days if blood eosinophils were ≥2% and placebo for lower eosinophil levels) and standard treatment (i.e., 14 days of oral steroids for all patients).
  • Only patients with elevated eosinophils seemed to benefit.
  • BET was linked to nonsignificantly fewer treatment failures (19% and 32%, respectively), defined as re-treatment, hospital admission, or death at 30 days.

Evidence increasingly suggests that oral steroid bursts are effective only in COPD exacerbations with eosinophilia. Although steroid side effects were uncommon in this study, even short courses of systemic steroids are not necessarily harmless.

Source: NEJM J-Watch | Read full story

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