Abstract Introduction Acute exacerbations of chronic obstructive pulmonary disease (COPD) are major contributors to morbidity, mortality, and accelerated lung function decline. Glucocorticoids are central to management, but the optimal duration of therapy remains controversial. Prolonged systemic glucocorticoid use has been linked to higher cardiometabolic risk and mortality. Given the frequency of exacerbations and potential harms of steroid exposure, minimizing duration without compromising outcomes is crucial. Methods Using the TriNetX Research Network, we identified adults (≥18 years) with an acute COPD exacerbation treated with systemic glucocorticoids between January 1, 2014, and January 1, 2024. Patients prescribed glucocorticoids for 5 days were compared with those receiving 14 days. Exclusion criteria included autoimmune disease, concomitant asthma, COVID-19-related exacerbations, long-term glucocorticoid use, and adrenal insufficiency. Propensity score matching (1:1) was used to balance demographics and clinical covariates including age, sex, race, BMI, smoking status, comorbidities, and cardiometabolic medications. Primary outcomes at 12 months included recurrent COPD exacerbations, glucocorticoid use, and all-cause mortality. Secondary outcomes were cardiovascular events, heart failure exacerbations, and healthcare utilization. Results Before matching, patients receiving 14 days of glucocorticoids were more likely to have a prior COPD diagnosis (61.1% vs. 50.1%), inhaled anticholinergic use (48.0% vs. 37.3%), inhaled beta-agonist use (48.0% vs. 37.0%), and prior glucocorticoid use (52.9% vs. 36.9%). After matching, 5,076 patients remained in each cohort. Compared to 5-day therapy, those on 14 days had higher rates of re-exacerbation (40.9% vs. 21.0%; OR 2.7, 95% CI 2.5-3.0), respiratory failure requiring mechanical ventilation (4.0% vs. 1.6%; OR 2.5, 95% CI 1.9-3.3), and subsequent glucocorticoid use (57.8% vs. 26.5%; OR 3.8, 95% CI 3.5-4.1). No mortality difference was observed. Extended-duration users had greater healthcare utilization (ER visits: 34.7% vs. 21.1%, OR 2.0; ICU admissions: 12.6% vs. 6.1%, OR 2.2) and poorer cardiovascular outcomes (heart failure exacerbations: 13.6% vs. 7.4%, OR 2.0; acute coronary events: 4.7% vs. 2.8%, OR 1.7). Discussion Prolonged glucocorticoid therapy during COPD exacerbations was associated with increased re-exacerbations, higher healthcare utilization, and worse cardiovascular outcomes, without mortality benefit. These findings highlight the potential harm of extended steroid use and support shorter treatment durations when clinically appropriate. This abstract is funded by: None
Gul et al. (Fri,) studied this question.