title: COPD exacerbations in general practice: variability in oral prednisolone courses.
abstract: BACKGROUND
  The use of oral corticosteroids as treatment of COPD exacerbations in primary care is well established and evidence-based. However, the most appropriate dosage regimen has not been determined and remains controversial. Corticosteroid therapy is associated with a number of undesirable side effects, including hyperglycaemias, so differences in prescribing might be relevant. This study examines the differences between GPs in dosage and duration of prednisolone treatment in patients with a COPD exacerbation. It also investigates the number of general practitioners (GPs) who adjust their treatment according to the presence of diabetic co-morbidity.
  
  
  METHODS
  Cross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands.
  
  
  RESULTS
  The response rate was 69%. Nearly every GP prescribed a continuous dose of prednisolone 30 mg per day. Among GPs there were substantial differences in treatment duration. GPs prescribed courses of five, seven, ten, or fourteen days. A course of seven days was most common. The duration of treatment depended on exacerbation and disease severity. A course of five days was especially prescribed in case of a less severe exacerbation. In a more severe exacerbation duration of seven to fourteen days was more common. Hardly any GP adjusted treatment to the presence of diabetic co-morbidity.
  
  
  CONCLUSIONS
  Under normal conditions GPs prescribe prednisolone quite uniformly, within the range of the current Dutch guidelines. There is insufficient guidance regarding how to adjust corticosteroid treatment to exacerbation severity, disease severity and the presence of diabetic co-morbidity. Under these circumstances, there is a substantial variation in treatment duration.
authors.affiliation: Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, FA 20, 9700 AD Groningen, the Netherlands.
authors.forename: Marianne
authors.initials: M
authors.lastname: de Vries
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Berendsen
authors.forename: Henk E P
authors.initials: HE
authors.lastname: Bosveld
authors.forename: Huib A M
authors.initials: HA
authors.lastname: Kerstjens
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
mesh_terms: D000284:Administration, Oral; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D019317:Evidence-Based Medicine; D005194:Family Practice; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011239:Prednisolone / Q000008:administration & dosage*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone