Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease
Walters, JAE and Wang, W and Morley, C and Soltani, A and Wood-Baker, R, Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease, Cochrane Database of Systematic Reviews , 2011, (10) Article CD006897. ISSN 1469-493X (2011) [Refereed Article]
Current guidelines recommend that acute exacerbations of chronic obstructive pulmonary disease (COPD) be treated with systemic
corticosteroids (SCs) for seven to 14 days. Intermittent SC use is cumulatively associated with adverse effects such as osteoporosis,
hyperglycaemia and muscle weakness. Shorter treatment could therefore reduce the risk of adverse effects.
To compare the efficacy of short-duration (seven days or fewer) and longer-duration (more than seven days) SC treatment of acute
COPD exacerbations in adults.
We searched the Cochrane Airways Group Register of Trials (to April 2011) Cochrane Central Register of Controlled Trials (to April
2011), MEDLINE (from 1950 to October 2010), EMBASE (from 1980 to October 2010) and the reference lists of articles.
Randomised controlled trials comparing different durations of SC (seven days or fewer or more than seven days). Other interventions,
e.g. bronchodilators and antibiotics, were standardised; studies in other lung diseases were excluded, unless data on participants with
COPD were available.
Data collection and analysis
Two review authors independently extracted data that were pooled themusing ReviewManager 5.We sought missing data fromauthors
of studies published as abstracts only.
We identified seven studies including 288 participants; two studieswere fully published and fivewere published as abstracts.We obtained
data for two studies published as abstracts from authors; these two abstracts and the two full papers contributed to meta-analysis. No
study specified COPD diagnostic criteria and only one specified exacerbation criteria. Short course treatment varied between three and
seven days and longer duration 10 to 15 days, at equivalent daily doses of corticosteroids; five studies used oral prednisolone (dose 30
mg, four studies, one tapered dose) and two studies used intravenous corticosteroid treatment. Mean ages of participants ranged from
64 to 73 years.We assessed the risk of allocation and blinding bias as low for these studies. Primary outcomes: risk of treatment failure
did not differ significantly by treatment duration, but the confidence interval (CI) was too wide to conclude equivalence (odds ratio
(OR) 0.94, 95% CI 0.38 to 2.36) (three studies, n = 158). Forced expiratory volume in 1 second (FEV1) did not differ significantly
when measured up to seven days (mean difference (MD) 0.07 L, 95% CI 0.19 to 0.05) or after seven days (MD 0.02 L, 95% CI 0.10
to 0.06) (four studies, n = 197). The likelihood of an adverse event (four studies, n = 102) did not differ significantly by treatment
duration, but again the CI was wide (OR 0.58, 95% CI 0.14 to 2.40).