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Oral prednisone prevents relapse in COPD exacerbations

J Fam Pract. 2003 October;52(10):747-769
By
Ursulla A. Courtney, MD
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  • BACKGROUND: The management of a COPD exacerbation is generally directed at relieving symptoms and restoring functional capacity. Steroids, along with bronchodilators and antibiotics, have been a mainstay of treatment for exacerbations, though evidence of benefit is scarce.
  • POPULATION STUDIED: Investigators enrolled 147 patients presenting to an emergency department with a COPD exacerbation. Patients were excluded for excessive reversibility with bronchodilators (implying a component of asthma), recent use of systemic steroids, evidence of pneumonia or congestive heart failure on x-ray, or if theyrequired admission.
  • STUDY DESIGN AND VALIDITY: Patients were randomized, using concealed allocation, to receive either oral prednisone 40 mg or matching placebo once daily for 10 days. All patients received inhaled albuterol 4 times daily, oral trimethoprim sulfa or doxycycline for 10 days, and inhaled ipratropium bromide for 30 days.
  • OUTCOMES MEASURED: Patients were monitored for relapse requiring a visit to a physician or the emergency department because of worsening dyspnea during the first 30 days after discharge.
  • RESULTS: The cumulative rate of relapse after 30 days of initiation of treatment was lower in the prednisone group than in the placebo group (27% vs 43%; number needed to treat=6). Patients also had improved dyspnea in the prednisone group, as measured by greater improvement on a dyspnea index scale (3.95 vs 2.07; P=.04). Improvement in COPD-specific measures of quality of life was only minimal in the prednisone group compared with the placebo group. Common side effects in the prednisone group were increased appetite, weight gain, and insomnia.
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PRACTICE RECOMMENDATIONS

A short course of oral prednisone in the outpatient setting prevents relapse and decreases dyspnea in patients with an exacerbation of chronic obstructive pulmonary disease (COPD). However, physicians should be aware of the potential for weight gain, increased appetite, and insomnia in patients taking this medication.

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