Although systemic steroid therapy is standard therapy for patients hospitalized for acute exacerbation of COPD, its use in the outpatient setting is still subject of debate. The aim of our study is to evaluate the differences in two groups treated for acute exacerbation of COPD (one group receiving systemic steroid therapy and one treated without), as well as their rate of clinic visit and hospitalization within 2 weeks.
Retrospective chart review of patients discharged from an outpatient setting with diagnosis of acute exacerbation of COPD and computerized pharmacy data for systemic steroid therapy usage in these patients. Data abstracted included patient’s demographic data, medical co-morbidities, FEV1 values, clinical presentation, antibiotic therapy, chronic steroid use and clinic and hospitalization within 2 weeks of initial presentation.
From June 2000 to May 2002, 98 patients treated for acute exacerbation of COPD met inclusion criteria. 52 patients were treated without systemic steroids (Group 1) and 46 patients received systemic steroids (Group 2). There was no difference in the age (69.7 vs. 67.9), female to male ratio (2% vs.4.5%), co-morbid state (73%vs. 74%), antibiotics usage (86.6% vs. 85%), clinic visit within 2 weeks (6%vs.17% P=0.07), or hospitalization within 2 weeks (2% in each group). However there was a statistically significant difference in the mean Fev1: 1.62L in Group 1 vs. 1.27L in Group 2 (p=0.007). Group 2 had 11(24%) patients on chronic steroid therapy vs. 0 patients in Group 1.CONCLUSIONS: In the outpatient setting, patients given systemic steroids for acute exacerbation of COPD have more severe airway obstruction and are more likely to be on chronic steroid therapy then patients treated without systemic steroids.
Systemic steroid therapy does not seem to offer any benefits in patients with milder airway obstruction on the short run. This study underlines the importance to incorporate the degree of airway obstruction in future prospective studies.
A.E. Temmar, None.