COPD treatment guidelines (e.g., GOLD) recommend 10-14 days of steroid therapy following a COPD exacerbation to prevent recurrences; the supporting data is weak.
A recent noninferiority trial (here) compared patients with a severe COPD exacerbation who received either a 5-day course (n=156) or 14-day course (n=155) of prednisone 40mg.
The results were:
No significant reduction in time until the next exacerbation (primary end-point)
No significant difference in mortality, incidence of mechanical ventilation, FEV1, or dyspnea scores (secondary end-points)
What you need to know:
This was a non-inferiority trial, which has limitations
All subjects received broad-spectrum antibiotics and an initial dose of IV steroid
Surprisingly, there were no differences between groups with respect to steroid complications (e.g., hyperglycemia, hypertension, etc.)
Bottom-line: 5 days of prednisone may be as effective as 14-days for COPD exacerbations.
