Cochrane for Clinicians

Putting Evidence into Practice

Different Durations of Corticosteroid Therapy for COPD Exacerbations

 

Am Fam Physician. 2019 Mar 1;99(5):295-296.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are shorter courses of systemic corticosteroid therapy as safe and effective as conventional, longer courses for patients with exacerbations of chronic obstructive pulmonary disease (COPD)?

Evidence-Based Answer

Treatment of acute exacerbations of COPD with a shorter course of systemic corticosteroids (seven or fewer days) is likely to be as effective and safe as treating with longer courses (more than seven days). There is no significant difference in adverse effects between shorter and longer courses.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

COPD is a chronic, progressive lung condition resulting in airflow limitations. Patients with COPD are at risk of acute exacerbations, which may present as dyspnea, increased cough, and sputum production. Systemic corticosteroids are a mainstay of treatment, but the necessary duration of treatment is debated. The authors of this review assessed whether a shorter course of systemic corticosteroids (seven or fewer days) was as safe and effective as the more conventional 10- to 14-day course.

This Cochrane review included eight studies and 582 patients.1 Five of the studies, which included 519 patients, were hospital based; the remaining three did not specify location. No studies specified whether patients completed the entire treatment course in the hospital. The mean age of participants was 65 to 73 years, and the proportion who were men ranged from 58% to 84%. The studies were conducted in Switzerland, Egypt, Bangladesh, China, Turkey, Thailand, and New Zealand. Only three studies discussed co-interventions, which varied among the studies but included oxygen, inhaled or nebulized bronchodilators, inhaled steroids, theophylline, and, in one study, a histamine H2 antagonist. When co-interventions were specified, they were applied to all participants. Two of the studies treated all patients with antibiotics, although details were not provided.

Author disclosure: No relevant financial affiliations.

References

1. Walters JA, Tan DJ, White CJ, Wood-Baker R. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2018;(3):CD006897.

2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: 2018 report. https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf. Accessed June 26, 2018.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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