Virginia Research Day 2025

Medical Student Research Clinical

13 Duration of Steroid Taper in Acute COPD Exacerbations with Acute Hypoxic and/or Hypercapnic Respiratory Failure to Prevent Hospital Readmissions

Satvika Nimmagadda, OMS-III; Houria Balmakhtar, DO; Lily Erdal, DO; Josh Collette, DO; William Cox, DO; Frederic Rawlins III, DO Corresponding author: snimmagadda@vcom.edu

Edward Via College of Osteopathic Medicine LewisGale Hospital Montgomery HCA Virginia Health System Salem VA Medical Center Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, with acute exacerbations significantly increasing morbidity and mortality¹. Systemic steroid therapy is a cornerstone of treatment, improving patient outcomes, reducing relapse rates, and mitigating exacerbation severity²,4. 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 COPD⁵. Optimal dosing, duration, and tapering of steroid therapy remain controversial due to current guideline variation, further necessitating research in this area6,7. Previous studies focused on the length and dosing of steroid therapy, but the benefits of tapering, as opposed to a conventional 5-day prednisone 40 mg course, have not been extensively investigated³. This study addresses this gap by comparing the effects of a 6-day versus 12-day steroid taper on readmission rates in discharged after hospitalization for acute COPD exacerbation with respiratory failure. The study also provides insights regarding optimizing

steroid tapering regimens for COPD exacerbations, potentially influencing clinical guidelines and patient outcomes. This retrospective observational study analyzed 176 adult patients hospitalized for acute COPD exacerbation with respiratory failure discharged on either a 6-day or 12-day prednisone taper for readmission dates within specified follow up periods. Statistical analyses included Chi-square tests to evaluate the relationship between the duration of steroid taper and readmission rates at 30 days, 3 months, and 6 months. The Wilcoxon Rank Sum test was used to compare the time to first readmission and the frequency of readmissions within 6 months between the two treatment groups. The study found no significant association between the 6-day and 12-day treatment groups for readmissions at 30 days (χ2(1) = 0.1073, p = .7432), 3 months (χ2(1) = 0.1305, p = .7179), or 6 months (χ2(1) = 0.2626, p = .6083). Additionally, there was no significant difference in the time to first readmission within 6 months (Z = -0.4131, p = .6795), within 30 days (Z = 0.0000, p = 1.0000), or within 3 months (Z = -0.3956, p = .6924).

The frequency of readmissions within 6 months (Z = 0.5252, p = .5994), 30 days (Z = -0.5319, p = .5948), or 3 months (Z = -1.0492, p = .2941) also showed no significant differences between the two groups. These findings suggest that a 6-day steroid taper is as effective as a 12-day taper in preventing readmissions for acute COPD exacerbations. Minimizing unnecessary steroid exposure can reduce treatment costs and the risk of adverse effects, focusing on harm prevention and promoting overall health and well being²,4,7. Additionally, a shorter steroid regimen can simplify treatment protocols, enhancing patient adherence and improving quality of life, especially for those with multiple comorbidities with COPD 6,8. However, the small sample size limits the results' generalizability, indicating that further research is needed to establish optimal steroid tapering regimens that maximize benefits while minimizing potential risk.

IRB Approval, 2023-968.

139 2025 Research Recognition Day