PURPOSE: An estimated 24 million people in the US have COPD and patients experience a mean of 1.3 exacerbations per year. Steroids hasten recovery and reduce early treatment failure during an exacerbation. Unfortunately, the optimal dose and duration of steroid use during COPD exacerbation remains unclear. Based on the GOLD and the ATS/ERS guidelines, giving 30-40 mg of oral prednisone per day for 7-14 days with a bronchodilator regimen is recommended if patients can tolerate oral medications. The purpose of the study was to determine if internal medicine housestaff prescribe more than 2 weeks of corticosteroids and more than 40 mg of prednisone per day on discharge for patients admitted for COPD exacerbation. If the problem existed, we wanted to determine if we could intervene by educating the housestaff with the recommendations.
METHODS: We reviewed 30 charts of patients discharged from April - November, 2010 with a diagnosis of COPD exacerbation. We excluded patients who had an exacerbation within the past month and patients on chronic steroids. We met with the housestaff on the first day of their inpatient rotation for 3 months. We then reviewed the charts of patients discharged with a diagnosis of COPD exacerbation during the months when we taught the housestaff. We had the same exclusion criteria.
RESULTS: Baseline data showed 10/30 patients were on steroids for more than 2 weeks and 16/30 patients were on >40 mg of prednisone per day on discharge. Preliminary data show 2/6 patients were on steroids for more than 2 weeks. Only one patient was on >40 mg of prednisone per day on discharge.
CONCLUSIONS: Internal medicine housestaff prescribe more than 2 weeks of steroids and more than 40 mg/day of prednisone on discharge for patients admitted with COPD exacerbation. The problem probably stems from the fact that the optimal dose and duration of steroids during a COPD exacerbation remains unclear.
CLINICAL IMPLICATIONS: We have to educate our housestaff on guideline recommendations regarding corticosteroid prescription during an acute COPD exacerbation.
DISCLOSURE: The following authors have nothing to disclose: Jose Angelo De Dios, Mohsin Ehsan, Mark Metersky
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