When treating acute exacerbations, what dose of oral steroids is best and should the dose reduction be tapered?
COPD exacerbations vary in severity and oral steroids will be indicated when they significantly affect the patient’s daily activities. Exacerbations will be more severe in patients with more advanced COPD and these are the patients most likely to need oral steroids. The evidence suggests that the main action of steroids is in the first few days of an exacerbation, and therefore, to minimise side-effects, I use prednisolone 30mg daily for seven to 10 days, without then tapering the dose. Milder exacerbations may just require an increase in inhaled steroid dose.
