Abstract Acute exacerbation of chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization and readmissions in the United States. While the GOLD guidelines recommend prednisone 40 mg (or equivalent) for a duration of 5 days in the acute management, real world application of this is guided by clinical judgement often leading to higher dosage/frequency of systemic corticosteroids. This study compares high-dose steroid therapy (methylprednisolone ≥80 mg or prednisone ≥100 mg daily) and low-dose steroid therapy (methylprednisolone 80 mg daily or prednisone 100 mg daily) in terms of length of stay (LOS) and 30-day readmission rates. This retrospective cohort study included inpatient admissions for acute COPD exacerbation between August 1, 2024, and August 1, 2025, who received IV methylprednisolone or prednisone equivalent. Patients with comorbid acute congestive heart failure, interstitial lung disease, ICU admission, or intubation within one hour of emergency department presentation were excluded. Propensity score matching (1:1) was used to balance the groups. The primary endpoint was LOS, while secondary endpoints included 30-day all-cause readmission and 30-day COPD exacerbation readmission. Equivalence hypothesis testing was performed using two one-sided tests of equivalence (TOST) with a clinically relevant effect size of ± 1 day. For secondary endpoints, Pearson’s Chi-Square tests were used. In the matched sample (N = 272), the mean age was 68.0 ± 10.4 years, and 61% of patients were on nasal cannula at admission. The TOST for equivalence was significant, indicating that the true effect of corticosteroid dosing was within the equivalence boundary of ± 1 day (α = 0.05). However, the independent samples t-test revealed no significant difference in LOS between the low-dose group (5.10 ± 4.18 days) and high-dose group (4.84 ± 2.96 days) (mean difference = 0.26 days, p = 0.55, 95% CI -0.61, 1.13). Similarly, the incidence of 30-day all-cause readmission (χ² = 0.27, p = 0.60) and 30-day COPD exacerbation readmission (χ² = 0.78, p = 0.78) did not differ significantly between groups. This study demonstrates no significant difference between high- and low-dose corticosteroid regimens for acute COPD exacerbation in terms of LOS and readmission rates. Our findings suggest that any true difference between dosing regimens is minimal and may not be clinically significant. Future research with larger sample sizes may further refine these findings. This abstract is funded by: None
Shah et al. (Fri,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: