A 5-day treatment with systemic glucocorticoids didn’t prove any less effective in COPD patients in the ED for acute exacerbations than 14-day treatment in terms of re-exacerbation within 6 months, according to study results published in JAMA online ahead of print.
During hospital stay, there was no increase in the requirement for mechanical ventilation with the short-term treatment regimen. Clinicians note the shorter course reduces glucocorticoid exposure.
“There was no difference between groups in time to death, the combined end point of exacerbation, death, or both and recovery of lung function. In the conventional group, mean cumulative prednisone dose was significantly higher, but treatment-associated adverse reactions, including hyperglycemia and hypertension, did not occur more frequently,” the authors wrote.
“There was no significant difference in recovery of lung function and disease-related symptoms, but the shorter course resulted in a significantly reduced glucocorticoid exposure. These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD.”
For the study, investigators randomized participants presenting to the ED with acute COPD exacerbation. Patients randomly received treatment with 40mg of prednisone daily for either 5 or 14 days in a placebo-controlled fashion. Of the 314 patients, 289 (92%) were admitted to the hospital, 311 were included in the intention-to-treat analysis and 296 in the per-protocol analysis.
A total of 56 patients (35.9%) reached the primary end point of COPD exacerbation in the short-term treatment group compared with 57 patients (36.8%) in the conventional treatment group. Time to re-exacerbation did not differ between groups.