Researchers Say Provider Education on Steroid Stewardship Is Warranted for AECOPD

A recent study is adding insight to previous research indicating that providers are not following consensus guideline on steroid prescribing for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), with a lack of knowledge surrounding the guideline representing a significant barrier.

Although dosing and duration of steroids may vary slightly between guidelines from various organizations, there’s a general consensus that low doses (40 mg) of oral prednisone are recommended; however, despite these guidelines, the researchers of the current study found that among 31 providers, initial dosing ranged from 40 to 625 mg/day, with just 4 (13%) of these providers prescribing 40 mg/day.

The recommendation of 40 mg of oral prednisone stems from the REDUCE trial, which found that higher doses of the steroid did not improve re-exacerbation rates, as well as that time to next exacerbation was longer in the lower-dose group.

The majority (65%) of providers in the current study reported that their dosing choices were based on their clinical experience or prescribing habits while nearly one-third (32%) of providers credited current evidence-based medicine for their dosing decisions. However, notably, just 5 (16%) of providers were able to accurately point to consensus guidelines for AECOPD.

Based on the findings, the researchers argue that “education on consensus guidance will need to be addressed for successful stewardship with a focus on the evidence behind using oral agents, lower doses and differentiating severity of illness.”

The researchers found that years of experience did not significantly sway a provider’s prescribing habits; providers with 4 or less years of experience on average prescribed 215 mg while providers with more than 4 years of experience on average prescribed 312 mg.

However, providers with less experience did prescribe shorter steroid durations, with a median of 5 days compared with a median of 8.5 days among more experienced providers. According to the researchers, this finding could suggest that newly qualified providers may be more up to date on practice guidelines compared with more experienced providers. As a result, education on stewardship will likely also have to incorporate “unlearning” models for these providers.

Looking at the prescribing patterns by their type of practice, the researchers observed that “ED providers reported a starting dose over twice than of non-ED providers. This will, therefore, be a sub-population of particular interest when implementing stewardship activities at the study facility,” they noted.

Reference

Cole J, Smith S. Provider perceptions on steroid dosing in AECOPD: laying the groundwork for steroid stewardship. Clin Respir J. Published online August 6, 2020. doi:10.1111/crj.13247