Corticosteroid Reduction in COPD
Corticosteroid Reduction in COPD
This study explores whether patients hospitalized with chronic obstructive pulmonary disease
 (COPD) exacerbation may have fewer days with prednisolone and with the same treatment effect
 by controlling the treatment by daily measurements of eosinophils.
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