Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease
Cochrane Reviews,  Clinical Article

Walters JAE et al. – The authors based assessment of the efficacy of short compared to longer duration systemic corticosteroid therapy for acute exacerbations of chronic obstructive pulmonary disease (COPD) in this review on four of the seven included studies for which data were available. The finding in this review that there is no significant increase in treatment failure with shorter systemic corticosteroid treatment for seven days or less for acute exacerbations of COPD, does not give conclusive evidence to recommend change in clinical practice due to a wide confidence interval around the estimate of effect.

Methods
  • The authors 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.
  • Two review authors independently extracted data that were pooled them using Review Manager 5.
  • The authors sought missing data from authors of studies published as abstracts only.

Results
  • The authors identified seven studies including 288 participants; two studies were fully published and five were published as abstracts.
  • The authors 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.
  • The authors 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).

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