2026 Southeastern Residency Conference

Authors: Logan Wildman, Vanessa Velazco, Tracey Bastian

Background: The use of systemic corticosteroids for acute chronic obstructive pulmonary disease (COPD) exacerbation has been associated with shortened recovery time, improvement in FEV1, decreased patient length of stay, and the prevention of treatment failure; however, differences in patient outcomes using varying corticosteroid dosing strategies has yet to be demonstrated in large scale randomized controlled trials. The purpose of this study is to compare the effects of corticosteroid dosing strategies on outcomes in acute COPD exacerbation.

Methods: This was a single-center, IRB exempt, retrospective chart review study. All patients selected for data extrapolation were hospitalized at Williamson Medical Center within the dates of September 1st, 2024 and September 1st, 2025. Patients were extrapolated for data collection utilizing the ICD diagnosis code for acute COPD exacerbation (J44.1). Patients were evaluated in a 1:1 ratio based upon the amount of cumulative prednisone equivalents they received within 48 hours of admission (>1.5 mg/kg of prednisone equivalents versus ≤1.5 mg/kg prednisone equivalents). Weight based grouping was utilized to account for the varying nature of physician preference in terms of systemic corticosteroid selection. Primary endpoints included total hospital length of stay and readmission rate within 30 days for recurrent COPD exacerbation. Secondary endpoints included need for mechanical intubation and change in oxygen requirements at discharge. Lastly, safety endpoints included: incidence of hyperglycemia, severe hyperglycemia, and nosocomial infection.  In total, 208 patients were identified for data collection. After exclusion, 128 patients were included for data extrapolation. Fisher’s t-test calculations were utilized to determine statistical significance for nominal and ordinal data. Mann-Whitney- U calculations were utilized when evaluating the statistical significance of continuous variables.

Results: In total 128 patients were included for analysis. 71 patients were assigned to the >1.5 mg/kg prednisone equivalents group and 57 patients were assigned to the ≤1.5 mg/kg prednisone equivalents group. Baseline characteristics were similar between the two groups, with the exception of weight (>1.5 mg/kg: 89.4kg vs ≤1.5 mg/kg: 68.6kg), BMI (>1.5 mg/kg: 29.9 kg/m2 vs ≤1.5 mg/kg: 24.2 kg/m2), and cumulative prednisone equivalents distribution (>1.5mg/kg: 318mg vs ≤1.5 mg/kg: 600mg). These baseline characteristics were determined to be statistically significantly different between groups. For primary outcomes, the utilization of >1.5 mg/kg prednisone equivalents within 48 hours of patient admission resulted in an average patient length of stay of 4.62 days and 6 instances of readmission for subsequent COPD exacerbation. In comparison, patients who received ≤1.5 mg/kg within 48 hours of admission were found to have an average length of stay of 5.58 days and 4 instances of readmission for subsequent COPD exacerbation. Differences between groups for both length of stay (U = 1781.5, p =0.123) and repeat admission for exacerbation (p = 1.00) were found to be statistically insignificant. For secondary endpoints, need for mechanical intubation (p = 1.00) and change in oxygen requirement at discharge (p = 0.562) were found to be similar between groups. Lastly, safety endpoints of hyperglycemia incidence (p = 1.00), severe hyperglycemia incidence (p = 0.196), and nosocomial infection incidence (p = 0.323) were determined to be similar among groups.
 
Conclusions:  There were no statistically significant differences in hospital length of stay or 30 day readmission rates in patients receiving >1.5 mg/kg prednisone equivalents when compared to  ≤1.5 mg/kg prednisone equivalents within 48 hours of admission for acute COPD exacerbation.  Secondary endpoints, including need for mechanical intubation and change in oxygen requirements at discharge, as well as safety endpoints, were similar between groups. Additional evidence from larger cohorts would be valuable in evaluating outcomes associated with varying corticosteroid dosing strategies in this patient population.