COPD Patients May Be Overtreated With Steroids
Study Shows Lower-Dose Steroid Treatment May Be as Effective as High-Dose
"Providers need to keep up on the guidelines," says Richard A. Mularski, MD, a clinical investigator and a pulmonologist at Kaiser Permanente Center for Health Research in Portland, Ore. Mularski is a co-author of an editorial that accompanied the new study.
Mularski speculates that doctors may reach for the bigger guns -- IV steroids -- because they view them as a more effective way to treat COPD. But "steroids are not without significant side effects, especially for hospitalized [patients], and you would want to avoid this by giving the right amount and not too much," he says.
Bigger is not always better when it comes to COPD treatment, says Neil Schachter, MD, a professor of pulmonary medicine and medical director of the respiratory care department at Mount Sinai Center in New York City.
"IV steroids have no benefit over the less expensive oral steroids in terms of hospital stays and mortality," he says.
When asked by WebMD if this study could change practice, Schachter says "while I don't think that this study will immediately change how doctors treat exacerbations, it certainly puts the spotlight on the need to refine criteria for IV steroid therapy."
But "these guidelines are guideposts, not laws," he says. "The changing recommendations and the need to individualize treatment make doctors reluctant to embrace every new study or guideline as soon as it is published," he says.
"I use inhaled and oral steroids in the patients I see in my office," Schachter says. "If someone is in severe distress in my office, I might give them an injection of steroids to rapidly relieve symptoms, knowing that there could be a significant delay if they have to go home and obtain oral medication from a pharmacy. Many of the patients with a COPD exacerbation come through the emergency room where they are given IV steroids as a reflex."
He says that one of the presumed criteria for admission to the hospital is that they need IV treatment. "Once they are on IV steroids, there may be an inertia to switch to oral medication as the exacerbation is brought under control," he says, adding that most of these individuals are already on oral steroids when they arrive at the emergency room.