Treatment With Systemic Steroids in Severe Chronic Obstructive Pulmonary Disease Exacerbations: Use of Short Regimens in Routine Clinical Practice and Their Impact on Hospital Stay

Abstract

IntroductionIt is not known whether clinical practice guidelines for the treatment of COPD exacerbations with short courses of systemic corticosteroids (SC-SCS) are followed in clinical practice. MethodProspective, observational cohort study in patients admitted due to severe COPD exacerbation. The primary endpoint was the percentage of patients who received SC-SCS as treatment for severe exacerbation (doses of 200–300mg for 5–6 days). Secondary variables were percentage of patients with duration or reduced dose, dose in the first 24h, days of intravenous systemic corticosteroids (SCS), and duration of hospital length of stay (LOS). Simple linear regression was performed with LOS as a dependent variable and multivariate analysis with factors associated with LOS. Results158 patients were evaluated. 4.4% (7) patients received SC-SCS, 8.7% received a reduced dose and duration was reduced in 15.8%. The median dose and duration of SCS were 602.5mg (200–1625) and 14 (4–36) days, respectively. We observed an association between days of SCS and LOS (P<.001) and doses of intrahospital SCS and LOS (P<.001). Factors associated with LOS were doses of intrahospital SCS received (0.01 [95% CI: 0.007–0.013]; P<.001), days of steroid treatment (0.14 [95% CI: 0.03–0.25], P=.009) and PAFI (pO2/FiO2 ratio) at admission (−0.012 [95% CI: −0.012 to -0.002], P=.015). ConclusionsThe SCS schedules used in routine clinical practice are longer and administered at a higher dose than recommended, leading to a longer hospital stay.