Corticosteroid Reduction in COPD

The most commonly used treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is a 5-day treatment with corticosteroids in moderate-high dose. Some patients receive repeated treatments, although it has been shown that corticosteroids only have temporary beneficial effects and no effect in relation to serious incidents or mortality. It has been found that the higher accumulated prednisolone dose disables patients due to serious side effects, including pneumonia, dysregulated diabetes, bone fracture in the context of osteoporosis, mental disorder and adrenal insufficiency etc. However, the extent of the side effects is unknown. Recent research has shown that it is presumably only a small subset of COPD patients who benefit from corticosteroid therapy. This group can be identified by the biomarker "blood-eosinophils" as already measured on most AECOPD patients during hospitalization.

This is a randomized, controlled, multi-center, non-Inferiority trial evaluating the effect of eosinophil guided corticosteroid therapy to patients with AECOPD. The aim of the study is to investigate whether the accumulated dose corticosteroid treatment during admissions for AECOPD can be reduced, including the presumed side effects, while (still) remaining the optimal treatment effect.

Inclusion criteria

• Patients hospitalized with AECOPD
• Age ≥ 40 years
• Spirometry-verified COPD (defined as FEV1 / FVC ≤ 70%)
• Chronic Obstructive Lung Disease (GOLD) class C or D
• Inclusion within 24 hours after admission

Exclusion criteria

• Known with a diagnosis of asthma
• Life expectancy less than 30 days
• Serious exacerbation requiring invasive ventilation or admission to ICU
• Allergy to systemic corticosteroids
• Severe mental illness, which is not controlled by medication
• People who are detained under the act on the use of coercion in psychiatry
• Severe language problems or inability to provide written informed consent
• Pregnancy and lactation
• Systemic fungal infections