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Corticosteroids for exacerbations of COPD
Giving corticosteroids orally in lower doses is as effective as giving the drugs intravenously at higher doses for the treatment of acute exacerbation of COPD (ae-COPD), according to a recent study in the Journal of the American Medical Association. The records of nearly 80,000 patients in more than 400 hospital admissions for ae-COPD who received steroids were reviewed. The primary outcomes were treatment failure, defined as the initiation of mechanical ventilation, inpatient mortality, or readmission within 30 days. The vast majority of patients (92%) received IV steroids. After multivariate adjustment, the death rate was similar in the two groups (1.4% IV therapy vs 1.0% oral) and the composite outcome was also similar (10.9% IV vs 10.3% oral). In a propensity-matched analysis, the risk of treatment failure was actually significantly lower among orally treated patients (odds ratio, 0.84; 95% confidence interval, 0.74-0.95), as was the length of stay and cost. Of the orally treated patients, 22% were switched to IV therapy later in the hospitalization.
The authors conclude that for patients admitted for ae-COPD, low-dose steroids administered orally are as effective, and may be safer, than higher-dose IV steroids (JAMA 2010;303:2359-2367). An accompanying editorial suggests that rather than doing large non-inferiority studies to confirm these findings, sufficient evidence exists to change practice now with continued comparative effectiveness research via linked registries (JAMA 2010;303:2409-2410).