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Regard L, Lazureanu PC, Pascal B, Laurichesse G, Rolland-Debord C. [Efficacy and toxicity of short-course corticosteroid therapy in chronic bronchial diseases]. Rev Mal Respir 2024:S0761-8425(24)00273-0. [PMID: 39389905 DOI: 10.1016/j.rmr.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/28/2024] [Indexed: 10/12/2024]
Abstract
Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are characterized by airway inflammation. While corticosteroids (CS) are frequently prescribed during exacerbations of these conditions, their repeated use is associated with numerous side effects. The aim of this review is to synthesize the recent literature on the indications, benefits, and risks of short-term CS therapy for these two diseases. French guidelines recommend short-term CS as a first-line treatment during asthma exacerbation (0,5 to 1mg/kg/day, not exceeding 60mg/day, for at least 5 to 7 days) or as a second-line treatment for COPD exacerbation (5 days, 30 to 40mg/day). However, these recommendations are not without limitations; they are primarily based on studies conducted in hospital settings, raising questions about the generalizability of their results to primary care, and as they employ a "one size fits all" strategy, they do not take into account the phenotypic heterogeneity of different patients. Moreover, repeated short-term CS courses generate side effects that even at low doses can appear early in young asthma patients, and they can exacerbate pre-existing comorbidities in COPD patients. The concept of a threshold dose should be employed in routine practice in view of accurately assessing the risk of side effects. In the near future, it will be important to consider recently published data supporting the use of predictive biomarkers for responses to CS, particularly in COPD cases.
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Affiliation(s)
- L Regard
- Service de pneumologie, Hôpital Cochin, AP-HP centre, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France; Unité INSERM U1016, Institut Cochin, Université Paris Cité, Paris, France
| | - P C Lazureanu
- Service de pneumologie, CHU de Clermont-Ferrand, université Clermont-Auvergne, 53, rue Montalembert, 63000 Clermont-Ferrand, France
| | - B Pascal
- Service de pneumologie, CHU de Clermont-Ferrand, université Clermont-Auvergne, 53, rue Montalembert, 63000 Clermont-Ferrand, France; Fédération des maladies allergiques d'Auvergne-Auvall, CHU de Clermont-Ferrand, université Clermont-Auvergne, 53, rue Montalembert, 63000 Clermont-Ferrand, France
| | - G Laurichesse
- Service de pneumologie, CHU de Clermont-Ferrand, université Clermont-Auvergne, 53, rue Montalembert, 63000 Clermont-Ferrand, France
| | - C Rolland-Debord
- Service de pneumologie, CHU de Clermont-Ferrand, université Clermont-Auvergne, 53, rue Montalembert, 63000 Clermont-Ferrand, France.
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Ramakrishnan S. Prednisolone for COPD exacerbations: time for a rethink. ERJ Open Res 2023; 9:00464-2023. [PMID: 37701365 PMCID: PMC10493706 DOI: 10.1183/23120541.00464-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
Prednisolone given universally for COPD exacerbations causes harm without any benefit. Patients deserve blood eosinophil-guided prednisolone treatment for COPD exacerbations. https://bit.ly/3pR2BSY.
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Affiliation(s)
- Sanjay Ramakrishnan
- Oxford NIHR Biomedical Research Centre and Nuffield Department of Medicine, University of Oxford, Oxford, UK
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
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