Clinical determinants for oral steroids during COPD-exacerbations in primary care

Rationale: International guidelines recommend a course of oral corticosteroids (OCS) in addition to bronchodilator therapy for the treatment of COPD-exacerbations, because systemic corticosteroids shorten recovery time, improve lung function and reduce treatment failure. The aim of this study was to examine which patient characteristics are associated with prescription of OCS by general practitioners (GPs) during COPD-exacerbations. Methods: This study comprised a database analysis of the centralized out-of-hours GP service in Amsterdam that serves a population of 750,000 people. Contacts were registered in an electronic medical record. We retrieved all records of patients treated for a COPD-exacerbation in 2008. Patients who received antibiotics were excluded. Documented symptoms and signs were coded as present/absent. We compared treatment with OCS with or without bronchodilator therapy versus bronchodilator therapy only. Data were cross-sectionally analysed. Results: 743 COPD-exacerbations were identified. 30.8% were referred to hospital and 69.2% were treated at home. Of these cases, 135 (54.8%) received OCS and 111 (45,2%) bronchodilator therapy only. Patients who received systemic OCS did not differ from those treated without OCS in age (68.9 vs 70.9±13.5, p=0.2), documented history, symptoms, hemodynamic characteristics, and lung sounds (p> 0.1). Conclusion: OCS with of without bronchodilator therapy are prescribed in 27.3% of COPD-exacerbations that are dealt with by GPs in an out-of-hour setting. We could not identify patient related determinants of the prescription of OCS. This suggests that the indication of systemic steroids during COPD-exacerbations requires clinical foundation.