Fast Five Quiz: Can You Properly Identify and Treat COPD?

Zab Mosenifar, MD

Disclosures

September 30, 2014

The use of systemic steroids in the treatment of acute exacerbations is widely accepted and recommended, given their high efficacy. A meta-analysis concluded that oral and parenteral corticosteroids significantly reduced treatment failure and the need for additional medical treatment, and that they increased the rate of improvement in lung function and dyspnea over the first 72 hours. Note that systemic steroids are not as effective in treating COPD exacerbations as they are in treating bronchial asthma exacerbations.

On the other hand, the use of oral steroids in persons with chronic stable COPD is widely discouraged, given their adverse effects, which include hypertension, glucose intolerance, osteoporosis, fractures, and cataracts. A Cochrane review showed no benefit at low-dose therapy and short-lived benefit with higher doses (> 30 mg of prednisolone).

Inhaled corticosteroids provide a more direct route of administration to the airways, and similar to other inhaled agents, they are only minimally absorbed. Consequently, aside from the development of thrush, the systemic adverse effects of these medications at standard doses are negligible. Despite the theoretical benefit, the current consensus is that inhaled corticosteroids do not decrease the decline in FEV1, although they have been shown to decrease the frequency of exacerbations and improve quality of life for symptomatic patients with an FEV1 of < 50%. The current ICSI guidelines conclude that inhaled steroids are appropriate in patients with recurrent exacerbations of COPD.

For more information on the treatment of COPD, read here.

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