Clinical Question Do oral or pare...

Clinical Question

Do oral or parenteral corticosteroids improve clinical results in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD)?

Evidence-Based Answer

Systemic corticosteroids improve symptoms of acute COPD exacerbations at three days and bring into the likelihood of treatment failure. There is no evidence that they make mortality or prevent recurrence at 30 days, still the existing studies may be too small to lay open such a benefit. Adverse meanings are common but generally are not serious.

Practice Pointers

This Cochrane review updates an earlier meta-analysis with brace new studies. Although systemic steroids are widely used for the treatment of acute COPD exacerbations, the authors stres that it is important to know the magnitude of their benefit and the expansion of associated side effects. The question of whether oral or intramuscular steroids are more effective was not addressed.

Four of the studies in this analysis involved oral prednisone with an initial dose of 30 to 60 mg tapering across nine to 14 days; in a fifth studious mood high-dose oral prednisone (2.5 mg through kg) was compared with a moderate dose (06 mg by kg). In studies of intravenous methylprednisolone (Solu-Medrol) a variety of dosing regimens were used, from a single 100-mg dose to 72 hours of methylprednisolone followed according to a 57-day prednisone taper.

Despite the differences between studies, the review authors were able to combine the deductions from seven studies of treatment failure and nine studies of mortality. Systemic corticosteroids reduc the likelihood of treatment failure (17 versus 28 percent P < 0001 number lacked to treat = 9), when treatment failure was defined as hospital admission or answer to the emergency department. couple studies looked at longer-term treatment failure as measured on hospital admission rates in the 30 days following treatment. Although researchers construct no significant difference between steroid and placebo clusters (11 versus 15 percent, respectively), these studies were too small for a clinically important difference to be evident, if the same existed. There also was no difference in short-term mortality rates, which were approximately 4 percent in the couple groups (n = 910). Respiratory symptom scores at 72 hours were significantly more likely to be improved if patients received steroids. However, adverse incidents were common; the number wanted to harm was 7 for any adverse event

In addition to steroids, albuterol (Ventolin) should be used for bronchodilation because of its short attack of action. Ipratropium bromide (Atrovent) may be added. Antibiotics also should be considered for exacerbations that are not clearly triggered by means of viral infections. (1)

Wood-Baker RR et al. Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. cochrane Database Syst rev 2005;(1):CD001288

REFERENCE

(1) institute for clinical orders improvement. health care Guidelines. chronic obstructive pulmonary disease. 4th ed Bloomington, Minn.: institute for clinical orders improvement, 2004.

The series coordinator for AFP is Clarissa Kripke, MD Department of Family and Community Medicine, University of California, San Francisco. n

COPYRIGHT 2005 American Academy of Family Physicians

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