Featured Research

from universities, journals, and other organizations

Different dosing, administration of corticosteroids for severe COPD shows comparable outcomes

Date:
June 15, 2010
Source:
JAMA and Archives Journals
Summary:
In contrast to clinical guidelines, new research finds that the vast major­ity of patients hospitalized for severe symptoms of chronic obstructive pulmonary disease (COPD) were initially treated with higher doses of corticoste­roids administered intravenously, with analysis indicating that these patients had outcomes comparable to patients who received the recommended and lower-cost, less-invasive treatment of low doses of steroids administered orally, according to a new study.

In contrast to clinical guidelines, new research finds that the vast major­ity of patients hospitalized for severe symptoms of chronic obstructive pulmonary disease (COPD) were initially treated with higher doses of corticoste­roids administered intravenously, with analysis indicating that these patients had outcomes comparable to patients who received the recommended and lower-cost, less-invasive treatment of low doses of steroids administered orally, according to a study in the June 16 issue of JAMA.

COPD is the fourth leading cause of death in the United States, affects more than 6 percent of adults in the U.S., and accounts for $32 billion in direct health care costs. "In 2006, there were approximately 600,000 hospital admissions for acute exacerbation COPD, making this 1 of the 10 leading causes of hospital­ization nationwide," the authors write. "Systemic corticosteroids are beneficial for patients hospitalized with acute exacerbation of COPD; however, their optimal dose and route of administration are uncertain."

Peter K. Lindenauer, M.D., M.Sc., of Baystate Medi­cal Center, Springfield, Mass., and colleagues investigated the use of cortico­steroids among patients hospitalized for acute exacerbation of COPD at 414 U.S. hospitals in 2006 and 2007. The researchers com­pared the outcomes of those initially treated with low doses of steroids ad­ministered orally to those initially administered steroids at higher doses intravenously during the first 2 hospital days. Among the outcomes the researchers analyzed included a composite measure of treatment failure, defined as the initiation of mechanical ventilation after the second hospital day, inpatient mor­tality, or readmission for acute exacerbation of COPD within 30 days of discharge.

Of 79,985 patients, 73,765 patients (92 percent) were initially treated with higher doses of steroids administered intravenously, while 6,220 (8 percent) began low doses of steroids given orally. A total of 1.4 percent of patients initially treated with intravenous steroids died during the hospitalization and 10.9 percent experienced the com­posite treatment failure outcome, whereas 1.0 percent of orally treated patients died during the hospitalization and 10.3 percent experienced the compos­ite outcome. A total of 1,356 patients (22 percent) initially treated with low-dose oral steroids were later switched to in­travenous therapy.

The researchers found that in analysis that 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.

"In this large observational study, we found that, in sharp contrast to the rec­ommendations contained in leading clinical guidelines, the vast major­ity of patients hospitalized for acute exacerbation of COPD were initially treated with high doses of corticoste­roids administered intravenously. This practice 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," the authors write.

"In light of the greater risks and higher costs as­sociated with high-dose intravenous treatment, opportunities may exist to improve care by promoting greater use of low-dose steroids given orally. Given the large numbers of patients hospital­ized with COPD each year in the United States, a clinical trial comparing these 2 approaches to management would be valuable."

Editorial: Acting on Comparative Effectiveness Research in COPD

Jerry A. Krishnan, M.D., Ph.D., of the University of Chicago, and Richard A. Mularski, M.D., M.S.H.S., M.C.R., of Kaiser Permanente and Oregon Health and Science University, Portland, write in an accompanying editorial that given the impracticality of testing every clinical intervention in large-scale clinical trials, greater use of linked registries may serve as the basis for rigorous observational comparative effectiveness research studies, like those by Lindenauer and colleagues.

"In the case of oral corticoste­roids for exacerbations of COPD, the data are sufficient to take action to change practice now. To ensure that potential ben­efits supported by observational data are realized, further follow-up evaluations are needed to measure time-trends in quality metrics, health outcomes, and health care costs."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. Peter K. Lindenauer; Penelope S. Pekow; Maureen C. Lahti; Yoojin Lee; Evan M. Benjamin; Michael B. Rothberg. Association of Corticosteroid Dose and Route of Administration With Risk of Treatment Failure in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. JAMA, 2010; 303 (23): 2359-2367 [link]
  2. Jerry A. Krishnan; Richard A. Mularski. Acting on Comparative Effectiveness Research in COPD. JAMA, 2010; 303 (23): 2409-2410 [link]

Cite This Page:

JAMA and Archives Journals. "Different dosing, administration of corticosteroids for severe COPD shows comparable outcomes." ScienceDaily. ScienceDaily, 15 June 2010. <www.sciencedaily.com/releases/2010/06/100615163121.htm>.
JAMA and Archives Journals. (2010, June 15). Different dosing, administration of corticosteroids for severe COPD shows comparable outcomes. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2010/06/100615163121.htm
JAMA and Archives Journals. "Different dosing, administration of corticosteroids for severe COPD shows comparable outcomes." ScienceDaily. www.sciencedaily.com/releases/2010/06/100615163121.htm (accessed July 30, 2014).

Share This




More Health & Medicine News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) — Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) — Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) — At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Generics Eat Into Pfizer's Sales

Generics Eat Into Pfizer's Sales

Reuters - Business Video Online (July 29, 2014) — Pfizer, the world's largest drug maker, cut full-year revenue forecasts because generics could cut into sales of its anti-arthritis drug, Celebrex. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



      Save/Print:
      Share:  

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile iPhone Android Web
      Follow Facebook Twitter Google+
      Subscribe RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins