COPD exacerbations in general practice: variability in oral prednisolone courses

BMC Family Practice

Research Article

Thys van der Molen¹  Annette J Berendsen¹  Henk EP Bosveld¹  Marianne de Vries¹  Huib AM Kerstjens² 

[1] Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, FA 20, 9700, Groningen, AD, The Netherlands;Department of Pulmonology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700, Groningen, RB, The Netherlands;

关键词: Prednisolone;    Severe Exacerbation;    Dutch Guideline;    Prednisolone Treatment;    Dutch College;   

DOI  :  10.1186/1471-2296-13-3

 received in 2011-10-12, accepted in 2012-01-12,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe use of oral corticosteroids as treatment of COPD exacerbations in primary care is well established and evidence-based. However, the most appropriate dosage regimen has not been determined and remains controversial. Corticosteroid therapy is associated with a number of undesirable side effects, including hyperglycaemias, so differences in prescribing might be relevant. This study examines the differences between GPs in dosage and duration of prednisolone treatment in patients with a COPD exacerbation. It also investigates the number of general practitioners (GPs) who adjust their treatment according to the presence of diabetic co-morbidity.MethodsCross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands.ResultsThe response rate was 69%. Nearly every GP prescribed a continuous dose of prednisolone 30 mg per day. Among GPs there were substantial differences in treatment duration. GPs prescribed courses of five, seven, ten, or fourteen days. A course of seven days was most common. The duration of treatment depended on exacerbation and disease severity. A course of five days was especially prescribed in case of a less severe exacerbation. In a more severe exacerbation duration of seven to fourteen days was more common. Hardly any GP adjusted treatment to the presence of diabetic co-morbidity.ConclusionUnder normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration.

【 授权许可】

Unknown   
© de Vries et al; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.