The recent European Respiratory Society (ERS) guidelines recommend oral corticosteroids in outpatients with chronic obstructive pulmonary disease (COPD) exacerbations, but it is a weak recommendation that may not be followed. Are there any evidence-based indications on who should receive oral corticosteroids?
Jadwiga Wedzicha, MD: I think one of the reasons that the ERS recommendations had such a low rating is that most of the studies of steroids at exacerbations have been performed in hospital settings. We have very few studies—and it is interesting why they were never done—performed in the community.
I think we are beginning to understand more how steroids work in COPD. There is no doubt that generally if patients are very breathless, it is affecting their activities of daily living, if they have got an acute exacerbation, for instance, that has been precipitated by a cold, then these are the patients who need a short course of oral steroids.
There is a bit of better evidence base about how long this course should be in the community. There is a study that compared 5 days versus 10 days, and 5 days was as good as 10 days. Steroids work very early at an exacerbation. In a community [administer] a short, 5-day course of steroids and stop. I think in a hospital setting it will of course depend on how well that patient is.