RCT

REDUCE

Short-term vs conventional glucocorticoid therapy in acute exacerbations of COPD

JAMA, 2013 · Multicenter double-blind randomized non-inferiority trial (n=314)

Clinical question

Is a 5-day course of systemic glucocorticoids non-inferior to a 14-day course in acute COPD exacerbations?

Population: Adults presenting to the ED with acute exacerbation of COPD
Intervention: Oral prednisone 40 mg daily for 5 days
Comparator: Oral prednisone 40 mg daily for 14 days
Primary outcome: Time to next COPD exacerbation within 180 days
Result: 5-day prednisone was non-inferior to 14 days for re-exacerbation risk (hazard ratio 0.95; 90% CI, 0.70 to 1.29; P=0.006 for non-inferiority) with similar mortality and shorter hospital stay.

What the trial found

5 days of systemic glucocorticoids is clinically non-inferior to 14 days, significantly reducing steroid exposure.

Current guideline position

GOLD guidelines recommend a 5-day course of systemic corticosteroids in acute COPD exacerbations (Evidence Category A).

Clinical interpretation

Established the 5-day oral prednisone 40 mg regimen as the international standard of care in AECOPD.

Clinical Context & Relevant Topics (1)

Disease Reference

Pathophysiology of acute-on-chronic hypercapnia, controlled oxygen targets (88–92%), evidence-based NIV, and auto-PEEP matching mechanics.