Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease (Review)
Walters, JAE and Gibson, PG and Wood-Baker, R and Hannay, M and Walters, EH, Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease (Review), Cochrane Database of Systematic Reviews, 2009, (1) EJ ISSN 1469-493X (2009) [Refereed Article]
COPD is a common condition, mainly related to smoking. Acute exacerbations of COPD, usually related to superimposed infection,
occur commonly and systemic corticosteroids are widely used in their management in combination with other treatments including
antibiotics, oxygen supplementation and bronchodilators.
To determine the efficacy of corticosteroids, administered either parenterally or orally, on the outcomes of acute exacerbations of COPD.
Searches were carried out using the Cochrane Airways Group COPD RCT register with additional studies sought in the bibliographies
of randomised controlled trials and review articles. Authors of identified randomised controlled trials were contacted for other published
and unpublished studies. The last search was carried out in August 2008.
Randomised controlled trials comparing corticosteroids, administered either parenterally or orally, with appropriate placebo control.
Other interventions e.g. bronchodilators and antibiotics were standardised. Clinical studies of acute asthma were excluded.
Data collection and analysis
Data were extracted independently by two reviewers. Data measured but not reported were sought from authors of included studies.
Trials were combined using Review Manager for analyses.
Eleven studies (n=1081) fulfilled the inclusion criteria and 10 studies contributed data for analyses (n=1051). There were significantly
fewer treatment failures within thirty days in patients given corticosteroid treatment, Odds Ratio (OR) 0.50; 95% confidence interval
(CI) 0.36 to 0.69 and Hazard Ratio 0.78; 95% CI 0.63 to 0.97. It would have been necessary to treat 10 patients (95%CI 7 to 16) with corticosteroids to avoid one treatment failure in this time period. Duration of hospitalisation was significantly shorter with
corticosteroid treatment, mean difference -1.22 days; 95% CI -2.26 to -0.18. For FEV1 there were significant treatment benefits with
mean differences at the early time point (to 72 hours), 140 ml; 95% CI 90 to 190 ml and at end of treatment (up to 15 days) 80 ml;
95% confidence interval 10 to 160. There was a significant improvement in breathlessness and blood gases at both time points. There
was no significant effect on mortality but an increased likelihood of an adverse event associated with corticosteroid treatment, OR 2.33;
95% CI 1.60 to 3.40. Overall one extra adverse effect occurred for every 5 people treated (95% CI 4 to 9). The risk of hyperglycaemia
was significantly increased, OR 4.95; 95% CI 2.47 to 9.91.