Systemic steroids in COPD-the beauty and the beast

Excerpt

The recommendations regarding the use of systemic steroids in COPD differ substantially depending on the phase of the disease. In moderate and severe acute exacerbations oral steroids are advocated based on the findings of several placebo-controlled trials that have been performed in secondary-care settings: these studies showed that systemic steroids improve lung function, dyspnoea and gas exchange. In addition, steroid use resulted in fewer treatment failures, a lower relapse rate and shorter hospital stays [1‐4]. Importantly, giving steroids orally is non-inferior to the i.v. application [5] and an 8-week treatment is not superior to a 2-week therapy [6]. Recently, it could even be shown that 5-day treatment is non-inferior to a 14-day course [7]. In the trial with longer term therapy [6] hyperglycemia requiring treatment was identified as considerable side effect, in the other trials no major adverse events were observed. …