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Am Fam Physician. 2004;69(5):1266-1267

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

Investigators reviewed randomized controlled trials using corticosteroids (oral or parenteral) to treat acute exacerbations of COPD. Studies that involved patients with acute asthma were excluded. Using Cochrane systematic review techniques, seven trials were included. The most common end point evaluated was forced expiratory volume in one second (FEV1) between six and 72 hours after treatment. FEV1 improved significantly after the use of corticosteroids. A few trials also noted a lower rate of treatment failure among patients who received steroid therapy. Adverse drug reactions were higher among patients in the trial group. 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, but adverse drug reactions are higher, and benefit on other outcomes is unclear.

In her commentary, Edmonds concludes that corticosteroids often are used in patients with acute respiratory symptoms secondary to COPD, even though there is no evidence of benefit on forced vital capacity (FVC) at 72 hours; on FEV1 or FVC after 72 hours; or on mortality, quality of life, or exercise tolerance. On the secondary outcome of treatment failures, defined as revisit to the emergency department or hospitalization, the beneficial effect of steroids may help to define patients who would receive more benefit from treatment. Although most 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.

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