Patients with acute exacerbations o...

Patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) frequently are treated with corticosteroids. A Cochrane systematic review abstract according to Wood-Baker and associates reviewing the utility of this approach is summarized with commentary from Edmonds

Investigators reviewed randomized controll trials using corticosteroids (oral or parenteral) to treat acute exacerbations of COPD Studies that involved patients with acute asthma were exclud Using Cochrane systematic review techniques, seven trials were included. The mostly common end point evaluated was forced expiratory turn in one second ([FEV.sub.1]) between six and 72 hours after treatment. [FEVsub1] improved significantly after the use of corticosteroids. A hardly any trials also noted a lower rate of treatment failure among patients who received steroid therapy. Adverse medicine reactions were higher among patients in the trial clump The conclusion of the Cochrane systematic review is that corticosteroids provide improved lung function during the first 72 hours after an acute exacerbation of COPD on the other hand adverse drug reactions are higher, and benefit upon other outcomes is unclear.

In her commentary, Edmond finishs that corticosteroids often are used in patients with acute respiratory symptoms secondary to COPD on the same level though there is no evidence of benefit in succession forced vital capacity (FVC) at 72 hours; upon [FEV.sub.1] or FVC after 72 hours; or forward mortality, quality of life, or exercise tolerance. onward the secondary outcome of treatment failures, defined as revisit to the push department or hospitalization, the beneficial purport of steroids may help to define patients who would receive more benefit from treatment. Although most numerous current guidelines recommend the use of corticosteroids in this population, further clarification of which patients with COPD should receive steroids during an acute exacerbation awaits further study

Edmond ML Are corticosteroids effective in acute exacerbations of chronic obstructive pulmonary disease? Ann Emerg M September 2003;42:426-8 and Wood-Baker R et al. Oral corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2003: CD001288

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