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Prehospitalization inhaled corticosteroid use in patients with COPD or asthma
C Jackevicius1, D P Joyce, S Kesten
1Asthma Centre of The Toronto Hospital, Ontario.
Background:
Guidelines for the treatment of obstructive lung diseases suggest a primary role of inhaled corticosteroids (ICs) in asthma, but only a minor role in COPD. However, surveys of physicians' prescribing habits have suggested that there is little difference in the use of ICs between these two conditions.
Objectives:
To determine the prevalence of IC use before and during hospitalization among patients with COPD or asthma.
Design:
Retrospective chart review.
Setting:
Tertiary care university teaching hospital.
Patients:
Adult inpatients, aged 18 or older, with physician-diagnosed COPD or asthma.
Measurements:
Patient-reported prescription drug use at hospital admission, and medical chart record of in-hospital and discharge prescriptions.
Results:
Of 350 charts reviewed, 102 patients were admitted to the hospital for unstable COPD, 133 patients had stable COPD, 36 patients were admitted with unstable asthma, and 79 patients had stable asthma. At hospital admission, 48% of unstable COPD patients, 26% of stable COPD patients, 56% of unstable asthma patients, and 44% of stable asthma patients reported having a current prescription for ICs. The proportion of all asthmatic patients reporting a current prescription for ICs at admission (48%) was significantly higher than the proportion of all COPD patients receiving an IC at admission (35%). However, there was no significant difference in the proportion of COPD and asthma patients with a current prescription of any form of corticosteroid (oral or inhaled). The proportion of COPD patients likely to respond to IC therapy is significantly different from the observed use at hospital admission.
Conclusions:
The proportion of patients found to be using ICs is much higher than the proportion expected to respond. There was little difference in the use of ICs for asthma and COPD patients at hospital admission. Most COPD patients using an IC were receiving the regimen on admission to hospital, indicating that there is need for education in the community and in the hospital regarding use of ICs in COPD patients.