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Outpatient Oral Prednisone for COPD

A simple once-a-day regimen may reduce the rate and time to relapse.

In a randomized, double-blind, placebo-controlled trial, these investigators tested the hypothesis that outpatient steroid treatment in patients discharged from the emergency department after an exacerbation of chronic obstructive pulmonary disease (COPD) would decrease relapse rates and prolong the time to relapse. They enrolled 147 patients who were discharged from 10 EDs in Canada and met inclusion criteria of documented COPD, no steroid use in the preceding 30 days or during the ED visit, and no severe comorbidity. Patients were randomized to receive 40 mg of oral prednisone once daily for 10 days or placebo; all patients received inhaled bronchodilators and antibiotics. The primary endpoint was relapse (defined as an unscheduled visit to a physician or a return ED visit within 30 days); secondary endpoints were degree of dyspnea, change in FEV₁, and quality of life.

The rate of relapse at 30 days was 27% in the steroid group and 43% in the placebo group (P=0.05; relative risk, 0.63). The time to relapse for 25% of the patients in each group was 23 days and 7 days, respectively (P=0.04). Compared with controls, patients in the prednisone group had greater improvements in FEV₁ and dyspnea but not in quality of life, most likely because of the side effects of insomnia and weight gain.

Comment: This study shows that a simple intervention of once-daily prednisone can provide benefit for COPD patients. Note that the much-revered "taper" was not a part of the regimen, making it easier for patients to comply with treatment.

— J. Stephen Bohan, MS, MD, FACP, FACEP

Published in Journal Watch Emergency Medicine July 30, 2003

Citation(s):

Aaron SD et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med 2003 Jun 26; 348:2618-25.

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