5 Days vs 14 Days of Steroids for COPD Exacerbations: The REDUCE Trial

Currently, guidelines advocate for systemic steroid therapy in the management of acute exacerbations of COPD. Multiple randomized clinical trials have shown the benefits on clinical outcomes of COPD (Reduction of LOS and quicker recovery of FEV1). The optimal dose and duration for COPD is not really known. Furthermore, long-term use of glucocorticoids can cause osteoporosis, diabetes mellitus, and most importantly is a risk factor for increased mortality in COPD.


What is the REDUCE Trial?
  • REDuction in the Use of Corticosteroids in Exacerbated COPD


What they did:
  • Randomized Placebo Controlled, Double Blind, Non-Inferiority Multicenter Trial
  • 5 Swiss Teaching Hospitals
  • 314 patients with COPD
  • Treatment with 40mg of prednisone daily for 5 days versus 14 days


Primary Outcome:
  • Time to next exacerbation within 180 days


  • Exacerbation rate 35.9% (short term treatment) vs 36.8% (conventional treatment)
  • Median time to exacerbation 43.5 days (short term treatment) vs 29 days (conventional treatment)
  • No difference in mortality
  • No increase in need for mechanical ventilation between treatment regimens
  • Hypertension developed or worsened in 11.6% (short term treatment) vs 17.8% (conventional treatment)
  • No difference in hyperglycemia in the two groups


  • All patients, regardless of GOLD classification were treated with inhaled long-acting Beta-agonists, glucocorticoids, and tiotropium
  • All patients received antibiotic treatment regardless of sputum production or procalcitonin level
  • Most of the patients in this study had severe or very severe COPD



5-day treatment with systemic glucocorticoids is non-inferior to 14 day treatment and significantly reduces glucocorticoid exposure


In my opinion, how will this affect your practice?
  • Patients in this study were over-treated with antibiotics, which is not the standard of care for hospitalized patients.
  • A 5-day treatment regimen is non-inferior to a 14 day regimen of glucocorticoids
  • It may be reasonable to treat patients with 5 days of glucocorticoids for COPD exacerbations

Leuppi JD et al. Short-Term vs Conventional Glucocorticoid Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: The REDUCE Randomized Clinical Trial. JAMA 2013; 309 (21): 1 – 9. PMID: 23695200


Dr. Salim R. Rezaie is a physician at the University of Texas Health Science Center at San Antonio. He is double board-certified in Emergency Medicine and Internal Medicine.

About Salim Rezaie

Dr. Rezaie completed his medical school training at Texas A&M Health Science Center, and followed that up with a combined Emergency Medicine/Internal Medicine residency at East Carolina University in Greenville, NC. Currently, he is an attending on the faculty of UTHSCSA in San Antonio, TX, where he focuses on medical education, social media as a tool for education (FOAMed), and building the bridges between internal medicine, critical care, and emergency medicine. Feel free to contact him on Twitter (@srrezaie) (@UTHSCSAPearls) about anything EM/IM! Salim Rezaie
June 6, 2013

In my practice, I don’t recall ever prescribing oral steroids for asthma/COPD longer than 5 days. I get better compliance and fewer side effects, while getting the same benefit.

June 6, 2013

I completely agree, guys. In my residency and practice, five days has been effective enough. I noticed some other attendings though always wanting to stretch steroids over a longer time using a taper even when there wasn’t a risk of adrenal insufficiency developing.

June 6, 2013

Exactly Matt. The guidelines still say 7 to 14 days, but anecdotally I agree 5 days is the way to go and this is what I do in my practice….And evidence as above supports this.


Got something to add?

Please log In or register for a free account to write a comment.