Should All Patients with COPD Exacerbations Receive Oral Steroids?

In a randomized trial, only patients with elevated eosinophils seemed to benefit.

Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend managing chronic obstructive pulmonary disease (COPD) exacerbations with 40-mg prednisone for 5 days, plus oral antibiotics for patients with excessive cough and purulence (NEJM JW Gen Med May 15 2023 and Am J Respir Crit Care Med 2023; 207:819). But whether steroids help all patients or just those with eosinophilia is unclear.

U.K. researchers compared two approaches for COPD exacerbations: blood eosinophil–directed treatment (BET; i.e., 30-mg prednisolone for 14 days if blood eosinophils were ≥2% and placebo for lower eosinophil levels) and standard treatment (i.e., 14 days of oral steroids for all patients). Of 308 patients enrolled, 93 had one or more exac…

Reviewing Author

David J. Amrol, MD

Disclosures

Speaker’s BureauAstraZeneca; Incyte

David J. Amrol, MD

Disclosures

Speaker’s BureauAstraZeneca; Incyte

Should All Patients with COPD Exacerbations Receive Oral Steroids?

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Reviewing Author