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Am Fam Physician. 2020;102(9):online

Clinical Question

What treatments are effective for patients with an exacerbation of chronic obstructive pulmonary disease (COPD)?

Bottom Line

Short-term antibiotic treatment and short-term systemic corticosteroids are both associated with a faster resolution of COPD symptoms and fewer treatment failures. (Level of Evidence = 1a)

Synopsis

The researchers searched several databases, including Cochrane CENTRAL, for English-language randomized controlled trials that evaluated treatments for exacerbations of COPD. Pairs of reviewers selected studies for inclusion, extracted the data, and evaluated the research quality. Based on 68 randomized trials, they found that antibiotic treatment of an acute exacerbation, regardless of severity, doubled the likelihood of resolution by the end of treatment (odds ratio = 2.03; 95% CI, 1.47 to 2.80) and halved the likelihood of treatment failure (odds ratio = 0.54; 95% CI, 0.34 to 0.86), with a moderate strength of evidence. Systemic corticosteroid treatment for one day to 56 days was associated with less frequent treatment failure but higher adverse effects, with a low strength of evidence. Current research does not provide good guidance on which antibiotic is best, or the optimum dose or duration of corticosteroid treatment. Other approaches (i.e., inhaled corticosteroids, inhaled bronchodilators, various inhaled combinations, aminophylline, magnesium sulfate, and anti-inflammatory treatments) had little or no effect on outcomes. Given the small number of studies for each comparison, the researchers were unable to determine publication bias. They did not find heterogeneity among study results due to the small number of studies.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Foundation

Setting: Various (meta-analysis)

Reference:DoblerCCMorrowASBeuschelBet alPharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis. Ann Intern Med2020;172(6):413–422.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.

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