Corticosteroid dosing in the treatment of acute exacerbations of COPD Kurt A. Wargo, Pharm.D., BCPS, Takova D. Wallace, Pharm.D. Candidate 2014, Ryan E. Owens, Pharm.D. Candidate 2014 Auburn University Harrison School of Pharmacy & Huntsville Hospital ObjectiveResultsResultsResults The goal of this study was to compare current practice trends in an 881-bed community hospital in North Alabama to established GOLD guideline recommendations for corticosteroid dosing in patients presenting during a COPD exacerbation. The GOLD guidelines offer specific recommendations for corticosteroid dosing, suggesting the administration of prednisolone 30 – 40 mg daily by mouth for 10 – 14 days. Clinically in our institution, we have recognized a trend in prescribers not following these guidelines, with much larger doses of intravenous (IV) corticosteroids being administered. Therefore, the main outcomes assessed in this study were: 1)evaluation of corticosteroid prescribing practices 2)impact of glycemic control while on steroids Methods Conclusions Institutional Review Board approved Retrospective, chart analysis conducted at an 881-bed regional referral hospital Exclusion criteria: Intensive care treatment < 40 years of age Concurrent respiratory disease Procedure: Medical history, specific pharmacotherapy for COPD prior to admission, in-hospital pharmacotherapy, and therapy upon hospital discharge were collected for analysis utilizing electronic medical records Diabetes status and elevations of glucose levels >180 mg/dL were recorded Table 1. Baseline Demographics The authors have no financial or personal relationships with any commercial entities to disclose Figure 3. Glucose trends in corticosteroid- induced hyperglycemia Male N=99 Female N=101 Age, yrs ± SD68.2 ± ± 9.96 African-American (n) Caucasian (n) Hispanic (n) 1 0 Home COPD Meds (n) None SABA SABA + SAAC Tiotropium Other combinations Theophylline Roflumilast Home O Concurrent Diseases (n) CHF MI Diabetes Discussion Table 2. Corticosteroid Dosing This study demonstrates the need for education on corticosteroid dosing in COPD exacerbations and the need to closely monitor glucose levels, especially in patients with diabetes Male N = 95 Female N = 95 Initial dose (n) Methylprednisolone 125 mg IV Methylprednisolone 80 mg IV Methylprednisolone 60 mg IV Methylprednisolone 40 mg IV Other dose or drug Cumulative dose (mg)1253 (80 – 8310) Corticosteroid dosing for acute exacerbations was found to be substantially higher & inconsistent with the GOLD guidelines In spite of the larger doses, the hospital length of stay was not impacted A large number of patients experiencing hyperglycemia Cumulative steroid dosing was lower among patients with diabetes; however, those patients were more likely to develop hyperglycemia Figure 2. Hospital Length of Stay Based Upon Corticosteroid Dose Figure 1. Average Corticosteroid Dose Diabetes (n=54) No Diabetes (n=146) Glucose > 180 on steroids (n, %) 49 (91)42 (29) Cumulative steroid dose (mg), (Avg ± SD, range) 928 ± 1107 (80 – 5110) 1687 ± 1756 ( ) Table 3. Glucose levels and steroid dosing in patients with and without diabetes