COPD exacerbations in general practice: variability in oral prednisolone courses

Cross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands.The 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.Under 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.COPD exacerbations have a profound and long lasting effect on quality of life and the frequency of exacerbations contributes to long term decline in lung function [1]. Treatment of a COPD exacerbation with oral or parenteral corticosteroids significantly reduces treatment failure, the need for additional medical treatment, and shortens hospital stay. It increases the rate of improvement in lung function and dyspnoea [2]. However, corticosteroid therapy is associated with undesirable side effects, especially weight gain, insomnia and hyperglycaemias [2,3]. The risk of these side effects depends on dosage and duration [4].The question is whether the potential benefits of treatment outweigh their risks. Optimum dosage and duration of treatment are not yet established [2]. Hospitalized patients all receive systemic treatment with corticosteroids. The Dutch College of General Practitioners (NHG) COPD Guideline recommends home tr