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IV Steroids May Be Overkill in COPD Patients
Date:6/15/2010

n IV drugs and 1 percent of those taking pills dying.

Meanwhile, 10.9 percent of IV patients and 10.3 percent of oral patients needed ramped-up care, such as mechanical ventilation, meaning the steroids simply weren't doing their job.

Patients taking pills as opposed to an IV line were also discharged more quickly and, not surprisingly, racked up fewer bills.

And many were probably spared the side effects of taking steroids, such as elevated blood sugar and blood pressure.

Twenty-two percent of patients on oral steroids were moved over to more potent IV drugs during their hospital stay.

The perceived "more is better" rule may be guiding many doctors' decisions, the experts said.

"In general, especially for hospitalized patients, more is considered better whereas in this case, probably less is more," said Mularski.

"Acute exacerbation of COPD is a life-threatening event so it's understandable that doctors want to pull out their big guns right away," added Edelman. "The attitude of doctors is more is better, but that's not true."

Ultimately, though, Edelman pointed out, not all guidelines agree on the correct use of corticosteroids in COPD patients, and decisions need to be made individually.

"It's hard to take thousands of patients and lump them into a model which treats them as a single patient," he said. "They have all kinds of different problems and different needs. Some may have diabetes that goes out of whack. Doctors actually have to make decisions."

More information

The U.S. National Heart, Lung and Blood Institute has more on COPD.



SOURCES: Richard Mularski, M.D., M.S.H.S., M.C.R., investigator and practicing pulmonologist, Kaiser Permanente Center for Health Research, Portland, Ore.; Norman H. Edelman, M.D.,
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