Rationale and evidence
Rationale
Despite their ongoing and frequent use, there is insufficient evidence regarding efficacy of systemic corticosteroids in the treatment of COPD without exacerbations. Well- known side-effects of this drug group are obesity, respiratory and peripheral muscle weakness, hypertension, psychiatric disorders, diabetes mellitus, osteoporosis, skin thinning and bruising. The burden of cardiovascular disease has a significant impact on all-cause mortality in COPD patients. The combination of limited efficacy and potential toxicity of the drugs, especially in the at-risk patients who tend to be older, less active and have histories of smoking, means that long term use of systemic corticosteroids in COPD is not recommended.
In the cases of the exacerbations of COPD, a 2018 systematic review from Cochrane suggests that a 5-day course of oral corticosteroids is likely to be sufficient and that the likelihood that shorter courses of systemic corticosteroids (of around 5 days) lead to worse outcomes compared with longer courses (10 to 14 days) is low.
Evidence
M Decramer, L M Lacquet, R Fagard, and P Rogiers. Corticosteroids contribute to muscle weakness in chronic airflow obstruction. American Journal of Respiratory and Critical Care Medicine Volume 150, Issue 1.
Falk JA, Minai OA, Mosenifar Z. Inhaled and systemic corticosteroids in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5(4): 506-512.
McEvoy CE1, Niewoehner DE. Adverse effects of corticosteroid therapy for COPD. A critical review. Chest. 1997 Mar;111(3): 732-43.
McGarvey LP, John M, Anderson JA, et al. Ascertainment of cause-specific mortality in COPD: operations of the TORCH Clinical Endpoint CommitteeThorax 2007;62:411 - 415.
Olof Selroos. (2004) 'The place of inhaled corticosteroids in chronic obstructive pulmonary disease'. Current Medical Research and Opinion. 20:10, 1579-1593.
N.M. Siafakas, P. Vermeire, N.B. Pride, et al. 'Optimal assessment and management of chronic obstructive pulmonary disease (COPD)'. Eur Respir J. 1995, 8, 1398–1420.
The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease 2019.
Walters JAE, Tan DJ, White CJ & Wood‐Baker R. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD006897.