Determining the optimal steroid treatment regimen for COPD exacerbations : A review of the literature
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In reviewing the literature, there is not a uniform approach to corticosteroid treatment when managing patients with COPD exacerbations. In general it is important to remember: Oral corticosteroids are as effective as IV corticosteroids in the management of most COPD exacerbations not requiring ICU admission. -- Short courses of prednisone (40mg daily for 5 days) are appropriate for most COPD exacerbations. -- Patients with frequent exacerbations of 2 or more per year or patients on chronic steroids may require a prolonged course of treatment. -- ICU patients have largely been excluded or not specifically studied in most analyses. Available literature shows that this subset of patients may benefit most from high-dose IV therapy for the first few days of treatment. Once patients are clinically improving, it would be reasonable to deescalate to oral therapy to limit unnecessary exposure.
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