COPD Exacerbations: Low-dose vs High-dose Steriods

by Joseph Esherick, M.D., FAAFP, FHM

Preface: Patients with COPD exacerbations requiring ICU admission did better with low-dose steroids vs high-dose steroids

Cohort study of 17,239 patients with COPD exacerbations admitted to the ICU
* ​1/3 required noninvasive ventilation
* 15% were intubated
* Virtually all received antibiotics and bronchodilators
* Methylprednisolone doses categorized as high >240 mg/day or low

Results
​* Similar in-hospital mortality
* Low-dose had shorter ICU stays, shorter hospital LOS, lower hospital costs, fewer ventilator days and lower rates of fungal infections.

This study confirms other studies that recommend the use of methylprednisolone 80-120 mg/day versus higher doses for COPD exacerbations even when patients require ICU admission. So please stop giving 125 mg IV methylprednisolone in the ER. It is not necessary!

COPD exacerbations requiring ICU admission do better with low-dose or high-dose steriods?

References:

Kiesr TH et al. Am J Respir Crit Care Med. 2014, May 1; 189: 1052. Link

Abroug F et al. Am J Respir Crit Care Med. 2014, May 1; 189: 1014. Link