Department of General Practice, University Medical Centre Groningen, University of Groningen, Antonius Deusinglaan 1, FA 20, 9700 AD Groningen, the Netherlands.
BMC Fam Pract. 2012 Jan 12;13:3. doi: 10.1186/1471-2296-13-3.
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.
Cross-sectional study among 219 GPs and 25 GPs in training, located in the Northern part of the Netherlands.
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.
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.
在初级保健中，口服皮质类固醇作为 COPD 加重期的治疗方法已得到广泛认可和循证支持。然而，最合适的剂量方案尚未确定，仍存在争议。皮质类固醇治疗与许多不良副作用相关，包括高血糖症，因此处方的差异可能具有相关性。本研究考察了 COPD 加重期患者中，初级保健医生在泼尼松龙治疗剂量和持续时间方面的差异。还调查了根据是否存在糖尿病合并症调整治疗方案的全科医生数量。
在荷兰北部地区，对 219 名全科医生和 25 名实习全科医生进行了横断面研究。
应答率为 69%。几乎每位全科医生都开了每天 30 毫克的泼尼松龙连续剂量。在全科医生中，治疗持续时间存在很大差异。医生开出了五天、七天、十天或十四天的疗程。七天的疗程最为常见。治疗持续时间取决于加重程度和疾病严重程度。在病情较轻的加重期，尤其会开出五天的疗程。在病情较重的加重期，七天至十四天的疗程更为常见。几乎没有全科医生根据是否存在糖尿病合并症调整治疗。
在正常情况下，全科医生在荷兰现行指南范围内相当一致地开具泼尼松龙处方。在如何根据加重严重程度、疾病严重程度和是否存在糖尿病合并症来调整皮质类固醇治疗方面，缺乏足够的指导。在这种情况下，治疗持续时间存在很大差异。
