Discussion
Long term systemic glucocorticoid therapy is not normally recommended
for the treatment of COPD [40]. Some patients with advanced COPD may
find it difficult to stop systemic glucocorticoids prescribed for
exacerbations, particularly where exacerbations are frequent. If
patients cannot stop glucocorticoids, the dose should be kept as low as
possible and the focus should be on preventing complications.
This patient feels breathless whenever he tries to reduce the dose of
his prednisolone. There is little evidence that long-term systemic
glucocorticoids improve lung physiology in people with stable COPD
[41], so this may be due to ‘psychological dependence’ on
glucocorticoids. A holistic approach would include: medical review to
look for other causes of breathlessness; optimising COPD management
(including smoking cessation, pulmonary rehabilitation and inhaler
review); symptom management and psychological support. Glucocorticoids
should be weaned in parallel to the lowest tolerated dose and measures
to ameliorate the dose-related and continuous use adverse effects of
osteoporosis (e.g. bisphosphonate treatment) and diabetes mellitus (e.g.
low sugar diet, oral hypoglycaemic treatment) should be implemented to
reduce the risks of future harm.