Corticosteroids for acute exacerbations of chronic obstructive pulmonary disease

Abstract

Background: Acute exacerbations occur quite commonly in patients with chronic obstructive pulmonary disease (COPD). Corticosteroid drugs, either parenteral or oral, are used commonly in this setting.

Objectives: To determine the effect of corticosteroids, administered either parenterally or orally, on the outcome in patients with acute exacerbations of COPD.

Search strategy: An initial search was carried out using the Cochrane Airways Group COPD 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 Authors of identified randomised controlled trials were contacted for other published and unpublished studies.

Selection criteria: Randomised controlled trials comparing corticosteroids, administered either parenterally or orally, with appropriate placebo. Other interventions were standardised e.g. bronchodilators, antibiotics. Studies of acute asthma were excluded.

Data collection and analysis: Data was extracted by one reviewer and sent to authors for verification. All trials were combined for analysis where possible.

Main results: We identified 7 studies that fulfilled the inclusion criteria. Outcomes were varied and few were common to all studies. The most commonly reported outcome, the FEV1 between 6 - 72 hours after treatment, showed no significant difference between corticosteroid and placebo treatment. Treatment failure (defined as re-attendance in the emergency department, need for oral steroids or hospitalisation) and quality of life did show a statistically significant benefit for corticosteroid treatment, but the number of studies reporting these outcomes was small and there was significant heterogeneity between them

Reviewer's conclusions: Treatment with oral or parenteral corticosteroids in outpatients may decrease the number of patients requiring further treatment or hospitalisation, but otherwise it has no significant effect on the outcome of acute exacerbations of chronic obstructive airways disease. Further research is required to determine the place of corticosteroid treatment in acute exacerbations of chronic obstructive airways disease.