In COPD, Oral, Intravenous Steroids Bring Same Outcomes

For exacerbations, oral low-dose steroids found no worse than high-dose intravenous steroids
By Jeff Muise
HealthDay Reporter

TUESDAY, June 15 (HealthDay News) -- Patients with chronic obstructive pulmonary disease (COPD) exacerbations treated with low-dose oral corticosteroids have outcomes similar to those treated with more costly and invasive high-dose intravenous corticosteroid therapy, according to research published in the June 16 issue of the Journal of the American Medical Association.

Peter K. Lindenauer, M.D., of the Baystate Medical Center in Springfield, Mass., and colleagues assembled data on 79,985 patients hospitalized for acute COPD exacerbations at 414 hospitals during 2006 to 2007. They compared outcomes over the first two days of hospitalization for those initially treated with oral low-dose steroids and those receiving intravenous high-dose steroids.

The researchers found that 92 percent of the patients were treated initially with intravenous high-dose steroids and 8 percent with oral low-dose steroids. In the intravenous group, 1.4 percent died and 10.9 percent experienced treatment failure, while in the oral group, 1.0 percent died and 10.3 percent experienced treatment failure. In multivariate analysis, treatment failure risk in the oral group was not worse than the intravenous group, while in propensity-matched analysis, treatment failure risk was lower in the oral group. Furthermore, patients in the oral group had shorter hospital stays and lower costs.

"Among the patients hospitalized for acute exacerbation of COPD, low-dose steroids administered orally are not associated with worse outcomes than high-dose intravenous therapy," the authors write.

Premier Healthcare Informatics of Charlotte, N.C., provided the data used in the study.

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