A narrative review of the use of oral corticosteroids in the management of stable chronic obstructive pulmonary disease

SummaryIn patients with chronic obstructive pulmonary disease, a short course of oral corticosteroids at doses of 30–40 mg prednisolone or equivalent, is associated with an average increase in FEV1 of 50–60 ml. The number needed to treat for a ⩾20% improvement in FEV1 is 7, similar to the number needed to harm of 9. While there is considerable individual variation in any response to oral corticosteroids, it is not possible to predict the individuals who will have a substantial benefit by methods other than a trial of treatment. There is no evidence that benefit may be maintained by oral corticosteroids, or converting to inhaled corticosteroids. As the chance of benefit from short course oral corticosteroids is balanced by the risk of developing adverse effects, there is little to support their use in stable COPD.