Short-Course Versus Long-Course Systemic Glucocorticoid Therapy for Hospitalized Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Prospective Comparative Study

Abstract

Background: Systemic glucocorticoids have a central place in the ICS of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Nevertheless, the best duration of corticosteroid therapy is a controversial issue as the long-term treatment is likely to cause more steroid-related adverse events in patients without any obvious improvement in clinical outcome. To measure the effectiveness and safety of short-course (5-day) and long-course (14-day) systemic glucocorticoid in hospitalized patients with AECOPD.

Methods: The study was carried out as a prospective comparative study in the Departments of Pulmonology in Shalamar Hospital and Farooq Hospital, Lahore, Pakistan. A total of 170 hospitalized patients with AECOPD were enrolled and equally allocated into two treatment groups (n=85 each). Group A was given oral prednisolone 40 mg/kg/day over 5 days and Group B given oral prednisolone 40 mg/kg/day over 14 days. The two groups got the same standard therapy, bronchodilators, oxygen when necessary, antibiotics when necessary, and nebulization, and supportive care. Success of treatment at Day 14 was the main outcome. Secondary outcomes were the ability to improve the forced expiratory volume in one second (FEV 1 ), length of stay in the hospital, relapse within 30 days and corticosteroid-associated adverse events. Statistics was done using SPSS version 26, and the statistical significance was p<0.05.

Results: The mean age of the participants was 63.8 ± 9.7 years, and 118 (69.4%) were male. Patients who received short-course therapy were successful in treatment (72/84.7) and those who received long-course were successful in treatment (70/82.4) (p=0.689). Improvement in FEV₁ was comparable between the groups (0.18 ± 0.09 L vs. 0.19 ± 0.10 L; p=0.522). Patients on the 5-day schedule had a much lower readmission (4.8 + 1.6 vs. 5.6 + 1.9 days; p=0.004). Thirty-day relapse rates were similar (16.5% vs. 14.1%; p=0.668). Hyperglycemia caused by corticosteroids was significantly less common in the short-course group compared to the long-course group (15.3% vs. 29.4%; p=0.028).

Conclusion: Clinical efficacy of short course systemic glucocorticoid therapy in patients with AECOPD hospitalized had been equivalent to conventional long-course therapy. The 5-day course on oral prednisolone was much better to hospital stay and corticosteroid-induced hyperglycemia in comparison to treatment success and chance of relapses. These findings validate existing guideline suggestions that advocate short-course systemic glucocorticoid treatment option as a superior and less risky treatment option to most hospital-admitted patients with AECOPD.