COPD exacerbation a contraindication for prednisone?

Dear Ask The Doctor: In a case of what seems to be COPD exacerbation, where the patient presented a new symptom of coughing up white froth after lying down at night, would a prednisone burst still be considered? (due to the potential side effect of edema.) he doesn't have any peripheral edema. I'm wondering if it is a more common side effect and what the thoughts are on benefit vs risk. If prednisone is not an option, what other medications might be considered? I'm asking for my father. He has not taken Prednisone before, so no info on how he reacts to it. Additionally, his salt intake is insane, (he says if he must eat flavorless eggs, life isn't worth living.) I can probably convince him to suffer through for a couple weeks without, though.

Dear Bonnie: Patients with COPD are susceptible to infections which may rapidly deteriorate their condition. It is estimated that 70 to 80 percent of COPD exacerbations are due to respiratory infections. Viral and bacterial infections cause most exacerbation, whereas atypical bacteria are a relatively uncommon cause. The remaining 20 to 30 percent are due to environmental pollution or have an unknown etiology. Successful management of acute exacerbation of COPD in either the inpatient or outpatient setting requires attention to a number of key issues such as :

• Identifying the cause of the exacerbation.
• Optimizing lung function by administering bronchodilators.
• Assuring adequate oxygenation and clearance of pulmonary secretions.
• Addressing any nutritional needs.

Supplemental oxygen is a critical component of acute therapy. A target oxyhemoglobin saturation of 90 to 94 percent is preferred. The major components of managing an acute exacerbation of COPD include inhaled short-acting bronchodilators (beta adrenergic agonists and anticholinergic agents), glucocorticoids, and antibiotics. Inhaled short-acting beta adrenergic agonists (eg, albuterol) are the mainstay of therapy for an acute exacerbation of COPD because of their rapid onset of action and efficacy in producing bronchodilation. Systemic glucocorticoids (prednisone), when added to the bronchodilator therapies improve symptoms and lung function, and decrease the length of hospital stay. Usually oral glucocorticoids are preferred and intravenous glucocorticoids are typically administered to patients who present with a severe exacerbation, who respond poorly to oral glucocorticoids and are not able to take oral medication. Most exacerbations are treated with full dose therapy (eg, prednisone 30 to 40 mg daily) for 7 to 10 days. The prednisone is then stopped if the patient is feeling better or tapered over another seven days if patent's symptoms are not relieved. I hope the information helps, I wish your father well.