Hi, my name is Satvika Namagata, and I'm a third-year medical student at BCom Virginia. Today I will be talking about duration of steroid taper in acute COPD exacerbations with acute hypoxic endohypercapnic respiratory failure to prevent hospital readmissions. Chronic obstructive pulmonary disease is the third leading cause of death worldwide, with acute exacerbations significantly increasing morbidity and mortality. Systemic steroid therapy is a cornerstone of treatment, improving patient outcomes, reducing relapse rates, and mitigating exacerbation severity. Despite its benefits, steroid treatment can cause adverse effects such as osteoporosis, increased rates of pulmonary infection, and adrenal suppression, complicating the clinical management of COPD. The gold guidelines from the Global Initiative for Chronic Obstructive Lung Disease suggest a five-day treatment course while the European Respiratory Society and the American Thoracic Society guidelines advocate for up to 14-day treatment. This discrepancy in recommended steroid treatment length can profoundly impact patient adherence and the economic burden on health care. The reduced trial showed that a five-day course of 40 milligram methylprednisolone was a non-inferior to a 14-day course with respect to the risk of exacerbation over six months of follow-up. This data suggests a shorter steroid course can be justified because it does not sacrifice efficacy. The recommendations by European Respiratory Society and American Thoracic Society for a 14-day course of systemic glucocorticoid therapy are grounded in the findings of the SCOPE trial, or systemic corticosteroids and COPD exacerbation trial. This trial demonstrated that a 14-day course of systemic glucocorticoids was effective in reducing exacerbations and risk of relapse when compared to both an eight-week course and a placebo. Guidelines that advocate for a longer steroid taper can affect the incidence of adverse effects, treatment costs, and treatment adherence, further necessitating research in this area. Our study addresses this gap by comparing the effects of a six-day versus 12-day steroid taper on readmission rates in patients discharged after hospitalization for acute COPD exacerbation with respiratory failure. It provides insights regarding optimizing steroid tapering regimens for COPD exacerbations, potentially influencing clinical guidelines and patient outcomes. This retrospective observational study analyzed adult patients hospitalized in Capital and South Atlantic Division HCA health care facilities from 2020 to 2022 for COPD exacerbation with acute hypoxic and or hypercapnic respiratory failure. Patients included were at least 18 years old, had COPD exacerbation and respiratory failure, and were discharged on either a six-day or 12-day prednisone taper. Exclusion criteria included COVID-19 positive patients, those with concomitant heart failure or pulmonary embolism, home oxygen therapy users, and those discharged without the specified steroid regimens. Out of 2,852 screened patient encounters, 176 patients met the inclusion criteria. Statistical analyses included chi-squared tests to evaluate the relationship between the duration of steroid taper and readmission rates at 30 days, 3 months, and 6 months. The Wilcoxon-Ransom test was used to compare the time to first readmission and the frequency of readmissions within 6 months between the two treatment groups. Data collected include patient demographics, treatment group assignment, and readmission dates within the specified follow-up periods. Osteopathic significance was assessed by considering the holistic impact of steroid taper duration on patient outcomes, including potential effects on respiratory function and overall health. Descriptive statistics on the data showed that the mean time to earliest readmission for patients on the 12-day taper was 21.167 days, as compared to 22.795 days on the 6-day taper. The mean time to earliest readmissions within 6 months for patients on the 12-day taper was 90.169, as compared to 87.109 on the 6-day taper. As you can see, we plotted the data from these descriptive statistics on these graphs. The study found no significant differences for readmission rates at 30 days, 3 months, or 6 months between the two groups. No significant differences were found in the time to first readmission within 6 months, 30 days, or 3 months as well. The frequency of readmissions within 6 months, 30 days, or 3 months between the two groups was also found to have no significant difference. As mentioned, the reduced trial showed that a 5-day course of 40-milligram methylprednisolone was non-inferior to a 14-day course, leading to preferred treatment for COPD exacerbations being a short-term steroid course. Our study differs from the reduced trial because of the inclusion criteria. Our study's inclusion criteria selected for patients with additional diagnosis of acute hypoxic or hypercapnic respiratory failure, which likely resulted in a sicker and more severe COPD exacerbation population from that of the reduced trial. Along the same lines, the reduced study was composed of ER patients, many of whom were discharged without admission, whereas our study was focused on admitted patients. Our findings suggest that a shorter steroid taper can be an equally effective treatment with a lower side effect profile, which is further supported by the data from the reduced trial. Compelling evidence suggests that a shortened treatment duration can enhance patient adherence to the prescribed regimen. A study by Hometowska described the leading cause of exacerbations of obstructive pulmonary disease is non-adherence likely due to early discontinuation of treatment or misplaced beliefs about the necessity, overuse, harmfulness, and long-term effects of the treatment. This is especially common among older patients with chronic conditions like COPD, significantly influencing their willingness and capacity to adhere. Notably, a shorter prednisolone taper course for COPD exacerbation treatment presents a viable strategy for increasing the rate of patient adherence and ultimately yielding improvements in treatment effectiveness. The study from Poon highlights the potential benefits of implementing a shorter steroid taper regimen in managing COPD exacerbations in critically ill patients. Through a randomized control trial, it was observed that patients subjected to a shorter steroid taper, five days or fewer, experienced a significant reduction in hospital stay duration compared to those subjected to an extended course greater than five days. These findings underscore the efficacy of shorter steroid taper in achieving standard patient outcomes while minimizing hospital resource utilization. By decreasing the length of hospital stays, this approach not only alleviates the strain on healthcare facilities, but also allows for a more judicious allocation of resources. Our findings show a six-day steroid taper is equally effective as a 12-day taper in preventing readmissions for COPD exacerbations. A shorter steroid treatment length would minimize unnecessary steroid exposure, reduce treatment costs, decrease risk of adverse effects, improve patient adherence, and decrease mortality rates of comorbidities with COPD. A larger sample size would increase the generalizability of the results for all COPD patients. Future studies should investigate if a shorter steroid taper leads to changes in the prevalence of long-term steroid-related side effects. Here are the references that were used for this study. Thank you for listening, and thank you for your time.

COPD exacerbations

steroid taper duration

hospitalized patients

treatment adherence

healthcare costs