Steroid use in COPD exacerbation: a quality improvement project at Regions Hospital, St. Paul, Minnesota [poster]
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Introduction: Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalizations and mortality in the United States. In practice, the dose and route of steroid administration in COPD exacerbations varies widely. Methods: A literature review was performed to identify the effectiveness of various steroid doses and administration routes used in the treatment of COPD exacerbations and compare it with what is done at Regions Hospital in St.Paul, MN. Results: Literature review demonstrated the benefits of using methylprednisolone 125 mg IV vs. placebo. Subsequent studies compared lower oral doses (20-80 mg prednisone) to high IV doses and found low-dose oral steroids to be equally effective with fewer side effects. Among patients admitted for COPD exacerbation (n=225), 39% received low-dose (20-80 mg prednisone equivalent) oral prednisone in the emergency department. 22% received higher doses or IV doses in the emergency department. The initial inpatient steroid dose of these same patients revealed that 66% versus 33% received low-dose compared to high-dose or IV steroids, respectively. Conclusion: Many physicians continue to prescribe unnecessarily high or IV doses of steroids for COPD exacerbations despite evidence suggesting that lower doses are equally effective and have fewer side effects. A creation of a COPD order set with a decision support tool is planned that includes information about the effectiveness of lower-dose oral steroids and encourages selection of lower doses for the initial treatment of these patients. A secondary analysis will be carried out one year after implementation to monitor the quality improvement.