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WEDNESDAY, June 25, 2003 (HealthDayNews) -- People with chronic obstructive pulmonary disease who need treatment in the emergency room should leave the hospital with a prescription for oral steroids along with antibiotics and an inhaler to help them breathe.
That's the conclusion of a study appearing in the June 26 issue of the New England Journal of Medicine.
Canadian researchers found that people who were given the oral steroid prednisone as part of their follow-up after being treated for a flare-up of chronic obstructive pulmonary disease (COPD) were less likely to have to go back to the hospital in a month than those who didn't take the drug.
"In Canada, only about 45 percent of patients were receiving prednisone after discharge from the emergency department," says the study's lead author, Dr. Shawn Aaron, an assistant professor of medicine at the University of Ottawa. "We wanted to see if [treatment] with prednisone
would improve the clinical outcome."
And it did, he says. Treating with prednisone "reduced relapses by 16 percent," according to Aaron, and also reduced shortness of breath and increased lung function.
COPD can actually be one of two diseases -- chronic bronchitis or emphysema -- or a combination of the two. The first symptoms of the disease are a mild shortness of breath and an occasional cough. As the disease progresses, sufferers develop a chronic cough and it gets harder for them to breathe. Smoking is the biggest risk factor for getting COPD. The American Lung Association estimates that 80 percent to 90 percent of all cases involve smokers.
More than 13 million Americans have COPD, which is the country's fifth leading cause of death, according to the National Heart, Lung, and Blood Institute. Almost 118,000 people in the United States die each year from COPD, the lung association reports.
For this study, Aaron and his colleagues enrolled 147 people with COPD who were being discharged from an emergency room after suffering a flare-up of the disease. They had been treated at 10 different hospitals across Canada. All had a history of cigarette smoking and were over 35 years old.
All of the study participants were given antibiotics and brochodilators, which are inhaled medications that help to open up the airways. Half of the participants also were given 40 milligrams of prednisone for 10 days; the other half received a placebo.
Within a month, 43 percent of the placebo group had to visit the emergency department again. But, only 27 percent of the prednisone group had to go back to the hospital within a month.
"If you're sick with an exacerbation of COPD, you should be treated with antibiotics, bronchodilators and prednisone," concludes Aaron.
Other pulmonary experts agree, saying the study confirms what is already going on in clinical practice in the United States.
"Systemic corticosteroids work," says Dr. Richard Irwin, who wrote an accompanying editorial in the journal.
"This study shows they provide clinical benefits," Irwin adds. "It's a small but statistically and clinically significant benefit." Irwin is chief of pulmonary, allergy and critical care medicine at the University of Massachusetts Memorial Medical Center.
Dr. Matthew Trunsky, a pulmonary medicine specialist at William Beaumont Hospital in Troy, Mich., concurs. "Steroids are beneficial," Trunsky says. "Early use of steroids, within hours of the onset of symptoms, helps prevent exacerbations."
But, he cautions, "We need to keep an eye toward minimal doses because steroids have many side effects."
Side effects from short-term use of oral steroids are generally minimal. In this study, Aaron says, the most common side effects were insomnia, increased appetite and weight gain. He also notes that the use of steroids has been associated with an increased risk of osteoporosis.
More information
To learn more about chronic obstructive pulmonary disease, visit the National Heart, Lung, and Blood Institute or the American Lung Association.
