COPD Patients May Do Fine With Shorter Course of Steroids
TUESDAY May 21, 2013 -- Less is more when it comes to steroid therapy for patients having severe bouts of chronic obstructive pulmonary disease (COPD), according to Swiss investigators.
Five days of glucocorticoid treatment with prednisone to treat COPD flare-ups was as good as the standard 14 days, but with fewer chances for adverse side effects, they said.
"We wanted to show that a shorter period of treatment was not less effective than 14 days," said lead researcher Dr. Jorg Leuppi, with the department of medicine at the University Hospital of Basel.
The shorter course of treatment had the same outcome as the longer course of treatment, the study found. "There is exactly the same time to recovery and exactly the same number of re-exacerbations," Leuppi said.
In addition, the shorter course of treatment meant fewer side effects from the drug, such as increased blood pressure and elevated blood sugar, he said.
The report was published May 21 in the online edition of the Journal of the American Medical Association to coincide with its Tuesday presentation at the American Thoracic Society meeting in Philadelphia.
COPD is a progressive disease involving bronchitis and emphysema -- often tied to smoking -- that makes it hard for patients to breathe. Patients periodically have flare-ups or exacerbations, when symptoms are at their worst.
Prednisone is a glucocorticoid pill that acts as an anti-inflammatory. Since a generic version is available, it is a relatively low-cost therapy.
"COPD exacerbations, which are the leading cause of medical hospitalization in the U.S. and elsewhere, can be treated with a five-day course of prednisone, which is a corticosteroid, not 10 to 14 days as recommended by most national and international guidelines," said Dr. Don Sin, a professor of medicine at the University of British Columbia, in Vancouver, and co-author of an accompanying journal editorial.
Corticosteroids are highly toxic drugs, he said. "Thus, by using a five-day versus a 10- to 14-day [course], we will prevent many steroid-related complications -- such as diabetes, osteoporosis and adrenal insufficiency -- without sacrificing any of the benefits of steroids for management of COPD exacerbations," he said. "There is no rationale for giving more steroids than this."
For the study, Leuppi's team randomly assigned more than 300 patients suffering from an acute COPD exacerbation to daily doses of prednisone for either five or 14 days.
The goal of the study was to see whether either treatment resulted in fewer new exacerbations of COPD over six months.
The researchers found that prednisone treatment resulted in about the same number of patients having new bouts of COPD. Among those who got five days of therapy, 56 had a new bout within six months; 57 patients given 14 days of therapy had a new flare-up.
The average time to a new exacerbation of COPD was 43.5 days in the short-term treatment group and 29 days in the standard treatment group, the researchers said.
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said that "while treatment with corticosteroids is often necessary in exacerbations of COPD, it has not been clear how long the treatment should be given."
"The authors found that a shorter duration of treatment with steroids was possible," he said. "The accompanying side effects were less, and total dose of steroids was less long term."
To learn more about COPD, visit the American Lung Association.
Posted: May 2013
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