Efficacy and Safety of Short-Course Versus Long-Course Glucocorticoids in Acute Exacerbation of COPD

Abstract

Objective: To estimate the effectiveness and safety of short-course versus traditional long-course systemic glucocorticoid therapy in hospital patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods: It was a prospective comparative study that involved 170 patients admitted with AECOPD randomly divided into two treatment groups (n = 85 each). Group A was treated to short-course therapy comprising of oral prednisolone 40 mg, one dose per day taken over 5 days, Group B got conventional long-course therapy, comprising of oral prednisolone 40 mg, given once a day and over 14 days. The two groups were subjected to normal management based on guidelines (including inhaled bronchodilators, controlled oxygen, when necessary, antibiotics in case of possible bacterial infection and supportive care). The main eventual finding was successful treatment on Day 14, which is considered any clinical improvement without use of any further systemic corticosteroids, mechanical ventilator, intensive care unit (ICU) admission, or in-hospital death. Outcomes measured secondary were forced expiratory volume in one second (FEV1), length of hospital stay, relapse, and corticosteroid adverse effects in 30 days.

Results: The study population mean age was 63.8 years old with a standard deviation of 9.7 years with 118 (69.4) of them being male. The short-course patients had 72 (84.7) patients treated successfully and the long-course patients had 70 (82.4) PR successfully, no significant difference being found between the two groups (p = 0.689). The mean improvement in post-treatment FEV₁ was comparable (0.18 ± 0.09 L vs. 0.19 ± 0.10 L; p = 0.522). There was also a significant difference in the mean hospital stay of patients undergoing short-course therapy compared to patients undergoing long-course therapy (4.8 ± 1.6 vs. 5.6 ± 1.9 days; p = 0.004). Relapse rates (30 days) were the same in the two groups (16.5% vs. 14.1%; p = 0.668). Nevertheless, hyperglycemia created by corticosteroids was much rarer in the short-course group as compared to the long-course group (15.3% vs. 29.4; p = 0.028).

Conclusion: Short-course systemic glucocorticoid therapy showed similar clinical efficacy to the conventional long-course therapy in hospitalized patients with AECOPD. Moreover, it was also found that shorter regimen was linked with fewer length of stay in hospitals and a much lower rate of corticosteroid hypoglycemia. The results can be utilized to justify administration of a 5-day oral prednisolone course as a safe and effective treatment measure in majority of COPD hospitalized patients with an acute attack.