June 12, 2013

DynaMed EBM Journal Volume 8, Issue 24

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: June 12, 2013

Expiration Date: June 12, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

James McLellan, PhD - Senior Medical Writer, DynaMed, Ipswich, Massachusetts, USA


Dr. Ehrlich, Dr. Fleming, Dr. McLellan, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 8, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 6, 2013. Term of approval is for one year from this date with the option of yearly renewal. Each weekly updated is approved for 0.25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1304158F


Last week 473 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 202 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

In Patients with Acute Exacerbation of COPD, 5-Day Course of Prednisone Is as Effective as 14-Day Course for Reducing Re-exacerbation
Reference: JAMA 2013 Jun 5;309(21):2223, (level 1 [likely reliable] evidence)

For patients with acute exacerbation of chronic obstructive pulmonary disease (COPD), international guidelines recommend a 10-14 day course of oral corticosteroids (GOLD 2013 Feb 13 PDF). Some data suggest that a shorter steroid course may be effective, but existing evidence is inconclusive (Cochrane Database Syst Rev 2011 Oct 5;(10):CD006897). The REDUCE trial compared the efficacy of a 5-day corticosteroid course to the recommended treatment duration for patients presenting to the emergency department with acute COPD exacerbations.

A total of 314 patients > 40 years old (mean age 70 years) presenting to emergency department with an acute COPD exacerbation were randomized to oral prednisone treatment (40 mg/day) for 5 days vs. 14 days and were followed for 6 months. All patients received methylprednisolone 40 mg IV on the first day, and oral prednisone treatment began on the second day. Patients also had broad-spectrum antibiotics for 7 days plus inhaled and nebulized short-acting bronchodilator 4-6 times daily while hospitalized, and during follow-up they had inhaled glucocorticoids, beta-2 agonists, and tiotropium. All patients had a history of ≥ 20 pack-years of cigarette smoking.

There were no significant differences in the rates of re-exacerbation in either intention-to-treat (35.9% with 5-day course vs. 36.8% with 14-day course) or per-protocol analyses (36.7% vs. 38.3% in analysis of 296 patients). The median time to re-exacerbation was 43.5 days with the 5-day course vs. 29 days with the 14 day course, and 5-day treatment was associated with significantly reduced cumulative steroid doses (mean 379 mg vs. 793 mg, p < 0.001). In analysis of 289 patients (92%) who were admitted to the hospital, 5-day treatment was associated with shorter hospital stay (median 8 days vs. 9 days, p = 0.04). There were no significant differences in mortality, need for mechanical ventilation, or adverse events.

For more information, see the Acute exacerbation of COPD topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

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