COPD Patients May Be Over-Treated With Steroids

Bigger is not always better when it comes to the treatment of chronic obstructive pulmonary disease (COPD). That is according to a new study published in The Journal of the American Medical Association, which found that more than 90% of acutely ill patients hospitalized for COPD receive high doses of steroids when lower-dose oral steroids may be just as effective.

Considered a beneficial way to treat acute exacerbations of COPD, the proper administration of steroids is still not fully understood by many healthcare providers. And though most clinical guidelines recommend treatment with 20-60 mg of an oral steroid daily, dosage and administration varies between hospitals.

“In sharp contrast to the leading clinical guidelines, the vast majority of patients hospitalized for acute exacerbation of COPD were initially treated with high doses of corticosteroids administered intravenously,” conclude study researchers led by Dr. Peter K. Lindenauer of Baystate Medical Center in Springfield, Mass.

However, this practice is not associated with any measurable benefits. It also exposes patients to the risks and inconvenience of an intravenous line, potentially unnecessarily high doses of steroids, greater hospital costs and longer lengths of stay.

The study looked at the use of steroids among COPD patients hospitalized at more than 400 hospitals during 2006 and 2007. Findings include 92% of patients being treated with high-dose IV steroids, with 1.4% of those patients dying during hospitalization. Comparatively, only 1% of patients receiving oral steroids died. Patients treated with oral steroids also had shorter hospital stays and fewer costs associated with treatment, compared to patients who received IV steroids.

“IV steroids have no benefit over the less-expensive oral steroids in terms of hospital stays and mortality,” says Dr. Neil Schachter, a professor of pulmonary medicine and medical director of the respiratory care department at Mount Sinai Center in New York City. “[And] while I don’t think that this study will immediately change how doctors treat exacerbations, it certainly puts the spotlight on the need to refine criteria for IV steroid therapy.”

Click Here to Access the Full Story on WebMD