New COPD-X guidelines back oral steroids

REVISED COPD-X guidelines support the treatment of acute exacerbations of COPD with systemic glucocorticoids and antibiotics.

Dr Richard Wood-Baker, director of cardiorespiratory medicine at the Royal Hobart Hospital, said evidence to support the use of oral steroids has become more robust.

The latest advice from the Australian Lung Foundation and the Thoracic Society of Australia and New Zealand was that treatment with systemic glucocorticoids had the best outcomes associated with it, he said.

“Antibiotics used for all exacerbations have an overall benefit, although if we could identify the patients with bacterial infections that group would benefit most from oral antibiotics,” he said.

The majority of evidence on antibiotics comes from their use in hospital settings, but GPs have tended to use them as the first treatment, perhaps “seeing them as carrying less risk than oral corticosteroids”, he said.

The new COPD-X guidelines include a new section on the evidence to support treatment of exacerbations with both prednisone and doxycycline, with superior outcomes in people receiving both agents compared to prednisone and placebo.

Dr Wood-Baker, who is also clinical professor of medicine at the University of Tasmania, advised careful tailoring of any therapy to the individual patient.

“If you are after a reduction in decline over years, you need to target smoking cessation, improved quality of life needs bronchodilator therapy and pulmonary rehabilitation, preventing acute exacerbations needs inhaled corticosteroids and up-to-date immunisations,” Dr Wood-Baker said.

In patients with more severe disease, the treating clinician may want to increase the use of different classes of medication.

“There’s increasingly more evidence that all three of those drug classes have independent effects, but if you put all three together you have an overall improved effect as well,” he said.

Other changes to the guidelines include recognising the importance of anxiety, depression and heart disease as major comorbidity factors in COPD patients. 

www.copdx.org.au