Journal article

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COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months

Author(s): Sivapalan P et al

BMJ Open Respiratory Research 2019; 6:e000407

Airway diseases
General respiratory patient care

Digest Author(s): Stylianos Loukides, e-Learning Director ERS Education Council / 18 April, 2019

The authors performed a nationwide observational cohort study that was based on linked administrative registry data between 1/1/2010 and 31/10/2017. 101152 patients with ECOPD were recruited and properly treated either with short term oral Cs [≤250mg ] or long term oral Cs[>250mg]. The main outcome was whether the long term treatment with OCS may negatively impact the risk of pneumonia, hospitalization and the all cause mortality. The results showed that long course with OCS was associated with increased 1 year risk of pneumonia, hospitalization and all cause mortality compared to the short course one. The aHR was 1,2, 1,3 and 1,8 respectively.


The above study has some practical applications. The use of steroids during an ECOPD remains controversial due to potential serious adverse events. A short and non repeatable course of steroids which does not exceed the recommended dose of 250mg equivalent of prednisolone is both safe and effective. On the other hand any long term courses may increase the risk of various events which are mainly related to disease deterioration.