Oral Corticosteroids as Effective as Intravenous Dosing in COPD

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States.  It affects more than 6 percent of adults in the US, and accounts for $32 billion in direct health care costs. Each year there are approximately 600,000 hospital admissions for acute exacerbation COPD, making this 1 of the 10 leading causes of hospitalization nationwide.

Systemic corticosteroids are known to be beneficial for patients hospitalized with acute exacerbation of COPD; however, their optimal dose and route of administration has, until now, been uncertain.

According to a new study published in JAMA , despite guidelines recommending use of the low-dose oral route, a higher-dose intravenous route was used in 92% of patients admitted to over 400 U.S. hospitals.

Researchers compared the outcomes of those initially treated with low doses of steroids administered orally to those initially administered high dose intravenous steroids during the first 2 hospital days.

The primary outcome analyzed was a composite measure of treatment failure, defined as the initiation of mechanical ventilation, in-patient mortality, or readmission for acute exacerbation of COPD within 30 days of discharge.

After results were adjusted for various factors including patient, hospital, and physician characteristics, the risk of treatment failure among patients given low doses of steroids orally was not significantly different from those treated with high-dose steroids intravenously. Also, pa­tients treated with low doses of steroids administered orally had shorter lengths of hospital stay and lower costs.

The authors concluded that the use of high dose intravenous steroids 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 intravenous line, potentially unnecessarily high doses of steroids, greater hospital costs, and longer lengths of stay.

An editorial in the same journal added that the results “are sufficient to take action to change practice now.”

Or as we frequently say here at Word on Health – less is sometimes more!