When do you consider extended steroid tapers for acute asthma or COPD exacerbations?

The data doesn't support extended tapers - 5 days of 40 pred equivalent are non-inferior, and extended courses can cause harm, including increases in mortality. I only use extended tapers for patients who have, in the past have rapid symptom recrudescence with the typical shorter course. Typically, these patients are on baseline low doses of steroids and are very difficult to control, and this is done with the input/at the request of their outpatient pulmonologist.

Totally agree with Dr. @Dr. First Last.