However, exacerbations of COPD may require therapy with a burst and taper of oral glucocorticoids. A recent cooperative study demonstrated that the oral glucocorticoids do result in moderate improvement in clinical outcomes in COPD exacerbations. Of interest, patients who received 2 weeks of oral steroids derived the same benefit as patients who received 6 weeks. The patient should be aware of the multiple adverse reactions associated with oral administration of glucocorticoids . The likelihood of adverse reactions increases with the duration of therapy.
Prednisone is the agent most commonly used, however, several oral agents are available.
These agents may differ in their glucocorticoid potency. Equivalent antiinflammatory dosages of different glucocorticoid agents are listed. Patients who do respond favorably to oral corticosteroids may benefit from adding inhaled corticosteroids to their usual medication regimen as the oral steroids are tapered. The role of inhaled steroids in COPD remains unclear. A multicenter trial in Europe and Australia suggests that all patients with COPD may benefit from inhaled steroids.