Oral prednisolone equals IV prednisolone for COPD exacerbation (POEM)

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The Pharmaceutical Journal
Vol 280 No 7507 p741
21 June 2008

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POEM (Patient-Oriented Evidence that Matters)

Oral prednisolone equals IV prednisolone for COPD exacerbation
POEM series

Clinical question Is oral prednisolone as effective as intravenous prednisolone for inpatient treatment of chronic obstructive pulmonary disease exacerbations?

Bottom line Oral steroids are as effective as intravenous (IV) steroids for non-severe exacerbations of chronic obstructive pulmonary disease (COPD). Because they are cheaper and less invasive, oral steroids should be the preferred treatment option.

Synopsis Although the oral bioavailability of corticosteroids is excellent, many doctors persist in using IV steroids for patients with exacerbations of COPD. In this study, 210 hospitalised adults older than 40 years with COPD and at least 24 hours of exacerbation were randomised to receive five days of oral or IV prednisolone (60mg daily) followed by a tapering oral dose. Patients with a severe exacerbation (pH<7.26 or PaCO₂>9.3 kPa) were excluded.

Allocation was concealed and patients were randomised using a minimisation protocol that balances groups for key parameters such as age, sex, smoking history and supplemental oxygen use. The primary outcome was treatment failure, defined as death, admission to the intensive care unit, readmission or the need to intensify treatment.

Groups were balanced at the start of the study and analysis was by intention to treat; withdrawals and exclusions were uncommon and similar between groups. There was no difference between groups in the primary outcome, either early (ie, within two weeks), late (ie, after two weeks) or overall. The treatment failure rate was relatively high in both groups, usually because of the need to intensify treatment.

Level of evidence 1b (individual randomised controlled trial with narrow confidence interval)

Reference de Jong YP, Uil SM, Grotjohan HP, Postma DS, Kerstjens HA, van den Berg JW. Oral or IV prednisolone in the treatment of COPD exacerbations: a randomized, controlled, double-blind study. Chest 2007;132(6):1741–7.

Funding Unknown/not stated