Oral corticosteroids for acute exacerbations of chronic obstructive pulmonary disease

Abstract

Background: Systemic corticosteroids are widely used in the management of patients with acute exacerbations of COPD, in combination with other treatments.

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 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 Authors of identified randomised controlled trials were contacted for other published and unpublished studies.

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

Data collection and analysis: Data was extracted by one of the reviewers and sent to authors for verification. All trials were combined using Review Manager (version 4.1) for analysis.

Main results: We have 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 a significant treatment benefit for corticosteroid over placebo treatment, weighted mean difference 120 ml 95% confidence intervals: 5, 190 ml. There were significantly fewer treatment failures in patients given corticosteroid treatment, but the number of studies reporting this outcome was smaller and there was significant heterogeneity between them. There was an increased likelihood of an adverse drug reaction with corticosteroid treatment.

Reviewer's conclusions: Treatment with oral or parenteral corticosteroids increases the rate of lung function improvement over the first 72 hours of an exacerbation of chronic obstructive pulmonary disease, but at a significantly increased risk of an adverse drug reaction. There is no evidence that this benefit is maintained after 72 hours, or that other outcomes are improved.