(1242) Systemic Steroid Dosing Practices for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Introduction: Clinical practice guidelines for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) exacerbation recommend 40mg prednisone-equivalents for 5 days. However, institutional practices can vary widely. The aim of this study was to assess pharmacists’ perceptions of actual systemic corticosteroid dosing practices for AECOPD versus guideline recommendations.

Methods: This was a cross-sectional study of licensed practicing pharmacists. A REDCap® survey instrument was developed, pilot tested, and distributed using professional organization member lists. The survey remained open for 1 month, and clicking the link constituted consent. Respondents not actively practicing and incomplete responses were excluded. Descriptive statistics were used.

Results: Forty-two completed responses were collected. Average respondent age was 37±6.8 years, and 52.4% identified as female. Most had been licensed for 11-15 years (n=13, 31%) and completed postgraduate training in critical care (n=19, 61.3%) or cardiology (n=6, 19.4%). Most practiced in institutional urban (n=23, 54.8%) or academic (n=10, 23.8%) sites within predominantly medical units. Interprofessional prescribing teams were common, and only 19% had protocols for steroids in AECOPD. Loading doses were used 50% of the time, and the preferred routes of administration were oral (n=24, 59.6%) and intravenous (n=17, 40.5%). The primary corticosteroids were methylprednisolone (n=18, 42.9%) and prednisone (n=24, 57.1%). Mean daily doses were 40-50mg prednisone-equivalents, and mean duration was 5 days. Deviations from standard practice occurred more infrequently (n=19, 45.2%) than frequently (n=9, 21.4%) due to indicators like oxygen saturation, comorbidities, and bacterial infections. Upon deviation, methylprednisolone (n=22, 52.4%) and prednisone (n=12, 28.6%) were the preferred agents, mean daily doses were 51-100mg prednisone-equivalents (n=20, 47.6%), and mean duration was 6-10 days (n=22, 52.4%). Most respondents indicated tapering doses (n=27, 64.3%), typically reducing by 5mg/day weekly (n=3, 7.1%) or by 10mg/day weekly (n=2, 4.8%).

Conclusions: Corticosteroid dosing practices for AECOPD generally followed guideline recommendations; however, there was variability upon deviations from standard practices.