Abstract
Recommendations of systemic steroids in COPD exacerbation rely on trials that excluded patients requiring ventilatory support.
in an open-label, randomised evaluation of oral prednisone administration, 217 patients with acute COPD exacerbation requiring ventilatory support were randomised (with stratification on the type of ventilation) to usual care (n=106), or to receive a daily dose of prednisone (1 mg·kg−1) for up to 10 days (n=111).
There was no difference regarding the primary end-point, in-ICU mortality: 17 deaths (15.3%) vs 15 deaths (14%), in steroid treated and in control groups, respectively (Relative risk: 1.08, 95%CI: 0.6–2.05). Analysis according to ventilation modalities showed similar mortality rates. NIV failed in 15.7% and 12.7% (RR: 1.25, 95%CI: 0.56–2.8, p=0.59), respectively. Both study groups had similar median mechanical ventilation duration, and ICU length of stay: 6 (3–12) days vs 6 (3.8–12), and 9 (6–14) vs 8 (6–14), respectively. Hyperglycaemic episodes requiring initiation or alteration of current insulin doses occurred in 55 patients (49.5%) vs 35 patients (33%) in prednisone and control groups, respectively (RR: 1.5, 95%CI: 1.08–2.08; p=0.015).
Prednisone did not improve ICU mortality or patient-centred outcomes in the selected subgroup of COPD patients with severe exacerbation. It significantly increased the risk of hyperglycaemia.
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