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How many days of steroids should be taken by people with COPD exacerbations severe enough to require hospitalization?
In 2013, the REDUCE trial (JAMA) suggested five days of systemic corticosteroids are as good as longer 10-14 day courses, among 314 patients hospitalized with severe COPD exacerbations. This contradicted the prevailing GOLD guidelines at the time, which suggested 10 days of steroids for COPD exacerbations.
The 2017 updated GOLD guidelines modified its previous recommendation, reducing the advised treatment course from 10 days to to 5-7 days of systemic corticosteroids for severe COPD exacerbations.
A 2018 Cochrane analysis supports the change in practice toward lower corticosteroid doses for COPD flares. Authors reviewed eight randomized trials enrolling 582 people with COPD exacerbations requiring hospitalization. Studies compared systemic steroids (oral or intravenous) given for one week or less, versus longer courses. Patients were elderly, more often men, and had severe symptoms.
There were no observed difference in outcomes between patients treated for shorter vs. longer steroids courses. Outcomes included length of stay, treatment failure, lung function, or time to the next COPD exacerbation. Because of the heterogeneity of the aggregated study data, confidence in the conclusions was moderate.
Most patients with severe COPD exacerbations should be treated with seven days or fewer of systemic corticosteroids. There is no reason to believe that longer steroid courses are helpful in patients with mild or moderate COPD either, although evidence is lacking for that conclusion. Some patients are exceptions and may require longer steroid courses to regain symptom control and functional status.