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GOLD guidelines recommend use of prednisone (40 mg daily) for 5 days for acute exacerbations of chronic obstructive pulmonary disease (COPD; NEJM JW Gen Med Jun 15 2017 and Am J Respir Crit Care Med 2017; 195:557). Researchers examined whether this one-size-fits-all approach could be tailored to individual patients, based on eosinophil counts.
In a randomized, open-label study, 318 Danish patients who were admitted with acute COPD exacerbations were randomized to standard steroid therapy or eosinophil-guided steroid therapy. All patients received 80 mg of methylprednisolone on day 1, followed by either 37.5 mg of prednisolone daily for 4 days or prednisolone just on the days when peripheral eosinophil count was ≥300 cell/mL. Most patients' f…