This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Go to /pro/cpd-dashboard page

This page is worth 0.05 CPD credits. CPD dashboard

Go to /account/subscription-details page

This page is worth 0.05 CPD credits. Upgrade to Pro

Steroid trial in COPD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Steroid trial:

e.g. 30 mg prednisolone orally for two weeks only and test reversibility, OR, a six week course of inhaled corticosteroid (beclomethasone 500 mcg bd or equivalent).

A substantial response (>400ml) may indicate asthma (1).

NICE suggests that routine reversibility testing is now unnecessary in patients with a convincing history and examination compatible with COPD, and it may even be misleading

  • this is because repeated spirometry can show small spontaneous fluctuations leading to inconsistency i.e. nonreproducibility
  • the response to long-term therapy is not helpfully predicted by acute reversibility testing
  • asthma and COPD can usually be distinguished on the basis of history and examination. In certain circumstances, where diagnostic doubt remains, or where the patient is thought to have both COPD and asthma, reversibility testing or serial PEF rate measurements should be carried out
    • asthma is suggested if there is
      • a large (>400ml) FEV1 response to bronchodilators
      • a large (>400ml) FEV1 response to 30mg oral prednisolone daily for two weeks
      • serial PEFR measurements showing 20% or greater diurnal or day-to-day variability

Notes:

  • there is no evidence to support the long-term use of oral steroids at doses less than 10-15 mg. Potentially harmful adverse effects e.g. diabetes, hypertension, osteoporosis would prevent recommending long-term use at these high doses in most patients (2)
  • with respect to reversibility testing (3)
    • according to the 2019 British Asthma Guidelines by the BTS and SIGN:
      • In adults with obstructive spirometry, an improvement in FEV1 of 12% or more in response to either beta- agonists or corticosteroid treatment trials, together with an increase in volume of 200 ml or more, is regarded as a positive test, although some people with COPD can have significant reversibility.
      • An improvement of greater than 400 ml in FEV1 strongly suggests underlying asthma. In children, an improvement in FEV1 of 12% or more is regarded as a positive test.

Reference:


Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.