COPD Exacerbation Steroid Duration — RACP Adult Medicine MCQ

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EasyRespiratoryCOPD Exacerbation Steroid DurationRACP Adult Medicine

A 60-year-old man with COPD is admitted with an infective exacerbation. He is commenced on prednisolone 40 mg daily. What is the recommended duration of systemic corticosteroids for a COPD exacerbation?

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Correct answer: E — 5 days

The REDUCE trial demonstrated that a 5-day course of systemic corticosteroids (prednisolone 40 mg daily) is non-inferior to a 14-day course for COPD exacerbations, with fewer corticosteroid-related adverse effects. The COPD-X guidelines (V2.78) and GOLD 2025 recommend 5 days of oral prednisolone 30–50 mg daily. Extension beyond 5 days is NOT routinely recommended and does not improve outcomes but increases adverse effects (hyperglycaemia, infection risk, myopathy).

Reference: Lung Foundation Australia/TSANZ – 2025 – COPD-X Plan; GOLD – 2025 – COPD Report