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COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67000 patients with COPD followed for 12 months

BMJ Open Resp Res 2019;6:e000407

Patients with COPD are at greater risk of developing pneumonia due to impairment of lung defence mechanisms and use of inhaled corticosteroids. higher rates of intensive care admission longer hospital stays, and increased mortality rates are also seen in patients hospitalised with COPD and pneumonia than in patients with pneumonia only.

Recommended treatment duration with oral corticosteroids (OCS) has dropped from 10-14 days in 2001 to 5-7 days currently (GOLD). While OCS have been reported to shorten the length of hospital stays, improve lung function and reduce the risk of early relapse and treatment failure in patients with non-pneumonia exacerbations, they are also associated with a number of adverse side-effects, including hyperglycaemia, fluid retention, weight gain, hypertension, diabetes mellitus, adrenal suppression, deep vein thrombosis, osteoporosis and increased fracture risk. However, the risk of severe infections and death following the use of OCS is unknown.

These study authors conducted a nationwide, observational cohort study to determine the association between duration of OCS treatment in outpatients with acute exacerbations of COPD and the risk of pneumonia hospitalisation and all-cause mortality during a one-year study period, and to explore how the timing of the exposure affects risk estimates.

Study participants (10,152) were drawn from the Danish Register of Chronic Obstructive Pulmonary Disease, had received a diagnosis between 1 January 2010 and 31 October 2017, and had received prednisolone prescriptions for the treatment of exacerbations. They were set in two groups: those on a short course of OCS (prednisolone below or equal to 250mg; n=6,002) and those on a long course (prescriptions above 250mg; n=4,150).

Long courses were associated with increased 1-year risk of pneumonia hospitalisation or all-cause mortality, pneumonia hospitalisation and all-cause as compared with the short course of OCS treatment. Future studies could focus on testing the results reported in this paper and investigating the possible causes of the increased all-cause mortality often associated with long courses of OCS.

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