Steroids in acute COPD exacerbations

COPD exacerbations are incredibly common, managed under respiratory and general medical units for the most part. The duration of higher dose steroids vary however – some give just a few days, others up to two weeks. The REDUCE trial from JAMA this month proves the optimal duration, comparing 5 with 14 days.

Essentially, just over 311 patients were looked at with both intention to treat and per protocol analysis. There wasn’t any difference etween time to re-exacerbation or mortality, meaning that you can get away with a shorter course of steroid. Presumably this would lead to less adverse reactions – this trial didn’t see any difference in hyperglycaemia or hypertension however.

So, five days seems like the way to go. Keep this in mind for next time – read the article here. And of course, don’t forget to re-iterate the importance of smoking cessation.

 

source | JAMA 

image | Pulmonary Pathology

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