O3.1 Oral corticosteroids

Long term use of systemic corticosteroids is not recommended (Postma 1988, Postma 1985, Decramer 1996, Decramer 1994, Decramer 1992) [evidence level I].  Indeed, caution in the long term use of systemic corticosteroids is necessary because of limited efficacy and potential toxicity in elderly patients. Some patients with stable COPD show a significant response to oral corticosteroids (on spirometry or func­tional assessment). Therefore, a short course (two weeks) of prednisolone (20–50mg daily) may be tried with appropri­ate monitoring. Short courses of oral corticosteroids (<14 days) do not require tapering. A negative bronchodilator response does not predict a negative steroid response (Senderovitz 1999). If there is a response to oral steroids, continued treatment with inhaled corticosteroidsis indicated, but these may fail to maintain the response (Senderovitz 1999Vestbo 1999).