The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines suggest systemic glucocorticoids in COPD exacerbation may improve outcomes, including recovery time, lung function, and oxygenation. A limited number of studies have investigated the use of IV dexamethasone for COPD exacerbations. Results from these studies vary. Some data demonstrated comparable efficacy between dexamethasone and methylprednisolone, while others showed significantly greater improvement with methylpr...
Per Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for chronic obstructive pulmonary disease (COPD), updated in 2023, oral glucocorticoids are considered equally effective as intravenous (IV) administration. Studies, mostly set in hospitals, suggest systemic glucocorticoids in COPD exacerbations can shorten recovery time, improve lung function and oxygenation, reduce the risk of early relapse and treatment failure, and decrease hospital length of stay (LOS). The recommended systemic corticosteroid dose is 40 mg of prednisone-equivalent daily for 5 days. Longer courses of oral corticosteroids were associated with an increased risk of pneumonia and mortality in one observational study. Even short courses of corticosteroids were associated with an increased risk of pneumonia, sepsis, and death. If a steroid-sparing regimen is needed, one study found that nebulized budesonide alone provides similar benefits to IV methylprednisolone. The only time systemic dexam...
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A search of the published medical literature revealed
2 studies investigating the researchable question:
Is there any literature to support dexamethasone use in COPD exacerbation? What dose is recommended if so?
Level of evidence
B - One high-quality study or multiple studies with limitations
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[1] Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of COPD 2023 Report. https://goldcopd.org/2023-gold-report-2/
[2] Cosmi D, Mariottoni B, Angori P, et al. C82 Dexamethasone in acute cardiopulmonary syndrome with hyperinflammatory state. European Heart Journal Supplements. 2021;23(Supplement_C):C1-C48. doi:10.1093/eurheartj/suab063
[3] Hosseini A, Doustimotlagh AH, Afrasiabifar A, Sedaghattalab S. Comparison of dexamethasone and hydrocortisone in management of exacerbated chronic obstructive pulmonary disease patient...