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22-06-2010 | Respiratory | Article

Low-dose oral steroids as beneficial for COPD as high-dose iv treatment

Abstract

Free abstract

MedWire News: High-dose intravenously administered systemic corticosteroid treatment provides no additional clinical benefit compared with low-dose orally administered systemic steroids for hospitalized chronic obstructive pulmonary disease (COPD) patients, research shows.

“Systemic corticosteroids are beneficial for patients hospitalized with acute exacerbation of COPD; however, their optimal dose and route of administration are uncertain,” explain Peter Lindenauer (Baystate Medical Center, Springfield, Massachusetts, USA) and team.

The researchers therefore studied data on 79,985 patients with a COPD exacerbation who were admitted to 414 US hospitals between 2006 and 2007, and who received systemic corticosteroids within the first 2 days of admission.

Of these patients, 92.0% were initially treated with intravenous (iv) high-dose systemic steroids administered, while the remaining 8.0% were initially treated with low-dose systemic steroids given orally. Overall, 22% of patients initially treated with oral steroids were later switched to iv therapy.

Outcomes measures included a composite measure of treatment failure, defined as the initiation of mechanical ventilation after the second hospital day, inpatient mortality, or readmission for an exacerbation within 30 days of discharge.

The researchers found that 1.4% and 1.0% of the iv- and orally treated patients, respectively, died during hospitalization, and 10.9% and 10.3%, respectively, experienced the composite outcome.

After accounting for factors such as age, gender, ethnicity, COPD severity, treatment switching, and comorbidities, the researchers found that patients treated with low-dose oral steroids had a similar risk for treatment failure as those treated with high-dose iv steroids, at an odds ratio of 0.93.

The researchers also note that patients treated orally with low-dose steroids had shorter lengths of hospital stay and lower costs than those treated with iv high-dose steroids.

The researchers conclude in the Journal of the American Medical Association: “We found that, in sharp contrast to the recommendations contained in leading clinical guidelines, the vast majority of patients hospitalized for acute exacerbation of COPD were initially treated with high doses of corticosteroids administered intravenously.

“This practice does not appear to be associated with any measurable clinical benefit and at the same time exposes patients to the risks and inconvenience of an iv line, potentially unnecessarily high doses of steroids, greater hospital costs, and longer lengths of stay.”

They add: “In light of the greater risks and higher costs associated with high-dose iv treatment, opportunities may exist to improve care by promoting greater use of low-dose steroids given orally.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Mark Cowen

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