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Self-administered prescriptions of oral steroids and antibiotics in chronic obstructive pulmonary disease: are we doing more harm than good?

Centre de recherche, Centre de pneumologie, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université3Laval, Québec, Québec, Canada

D. Chrétien

Clinique MPOC, Hôpital St-François d'Assise, Centre Hospitalier Universitaire de Québec, Québec, Canada

F. Maltais

Centre de recherche, Centre de pneumologie, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université3Laval, Québec, Québec, Canada, Clinique MPOC, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, Québec, Québec, Canada

K. Pelletier

Clinique MPOC, Hôpital St-François d'Assise, Centre Hospitalier Universitaire de Québec, Québec, Canada

J.-G. Parent

Clinique MPOC, Hôpital St-François d'Assise, Centre Hospitalier Universitaire de Québec, Québec, Canada

Y. Lacasse

Centre de recherche, Centre de pneumologie, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université3Laval, Québec, Québec, Canada, Clinique MPOC, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, Québec, Québec, Canada, Yves.Lacasse{at}med.ulaval.ca

Patients with chronic obstructive pulmonary disease (COPD) are often given a prescription for a short course of oral steroids and antibiotics for self-administration during an acute exacerbation. The main objective of this study was to determine the impact of such prescriptions on medical care utilization, and steroids and antibiotics intake. This retrospective cohort study included patients with moderate to severe COPD participating in a self-management programme. We compared the number of unplanned medical visits (including hospitalizations) and the utilization of systemic steroids (number of short courses, number of days on treatment) and antibiotics (number of treatments) over a period of six months following registration to the programme in patients who received such a prescription and those who did not. Data were collected from hospital and community pharmacy files. A total of 89 patients were included; 46 received a self-administered prescription. During the study period, we found no difference between the two groups in the number of unplanned medical visits. However, we observed small but significant differences in the number of short courses of Prednisone (P = 0.018) and antibiotics (P = 0.006). This translated in an important difference in the number of days on steroids over the same period (`Prescription' group: 26; controls: 8; P = 0.005). Self-administered prescriptions may increase steroids and antibiotics utilization in patients with moderate to severe COPD, without reducing the number of unplanned medical visits. Chronic Respiratory Disease 2007; 4: 143—147

Key Words: antibiotics • COPD • exacerbation • health care utilization • self-management • steroids

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