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Hospital treatment of acute COPD rarely guideline-based

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Nine times out of 10, patients admitted to a U.S. hospital for acute exacerbation of chronic obstructive pulmonary disease (COPD) are treated initially with high doses of intravenously-administered corticosteroids — instead of low doses of oral steroids as current clinical guidelines recommend, according to an observational study.

Furthermore, starting with high-dose IV steroids does not produce any measurable clinical benefit over starting with low-dose oral steroids, yet it adds risk, inconvenience, and cost, researchers report in the June 16 issue of the Journal of the American Medical Association.

COPD is a leading cause of hospitalization in the U.S., and accounts for $32 billion in direct health care costs, Dr. Peter K. Lindenauer of the Center for Quality Care Research, Baystate Medical Center in Springfield, Massachusetts, and colleagues note in their report.

Most clinical guidelines recommend starting with low doses of oral steroids (20 to 60 milligrams oral prednisone once daily) rather than higher doses of intravenously administered methylprednisolone.

However, when Dr. Lindenauer’s group reviewed the records of 79,985 patients hospitalized for acute COPD exacerbation at 414 U.S. hospitals in 2006-2007, they found that 92% (73,765) were initially treated with high doses of IV steroids (average 600 mg/d prednisone equivalent), while only 8% (6,220) were initially treated with low doses of oral steroids (average 60 mg/d prednisone equivalent).

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