Similar efficacy of short-term (≤ 7 days) versus prolonged use of corticosteroid therapy during an exacerbation of chronic obstructive pulmonary disease

SOURCE

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

CONTEXT

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the world. It is projected to rise to 4.5 million deaths in the year 2020. Ten percent of patients with COPD exacerbation (COPDE) do not return to their previous condition within 3 months.

Guidelines recommend treating COPDE with systemic corticosteroid (SC) for 7 to 14 days.  However, the use of intermittent SC is associated with adverse events (AE) such as high blood pressure, hyperglycemia, osteoporosis, vertebral compression, and deleterious effects on peripheral and respiratory muscles.

CLINICAL QUESTION

Is short-term SC therapy (≤ 7 days) in patients hospitalized for COPDE not requiring ventilation (invasive or not) as effective as a SC therapy for greater than 7 days?  Does a short-term SC reduce AE?

BOTTOM LINE

The effectiveness of the two therapeutic strategies does not differ in terms of treatment failure, recurrence rates and interval between COPD exacerbations (moderate quality evidence).

There is no significant difference in the risk of hyperglycemia (moderate quality evidence), hypertension, gastrointestinal bleeding, gastroesophageal reflux, heart failure or ischemic heart disease, sleep disorders, fractures and depression. There is no significant difference on mortality (moderate quality evidence), the length of hospitalization with a follow-up of 14 to 180 days (moderate quality evidence), lung function (very low quality evidence), blood gases, dyspnea rating and quality of life.

CAVEAT

Conducting studies on this subject is difficult with several studies not yet completed. The definition of COPDE was neither consistent nor precise in the included studies. This meta-analysis did not include patients with minor to moderate COPDE: the authors point out that studies in this group of patients are needed.  Finally, the follow-up may be too short to detect potential differences in relapse, mortality and readmission rates.

AUTHORS INFORMATION

Y. Auffret
Urgences, CHUR de Brest
Brest, France
y.auffret@ch-cornouaille.fr

S. Beroud
Service d’Accueil des Urgences, CHU Lyon Sud,
Lyon, France
sebastien.beroud@chu-lyon.fr

K. Magee
Dalhousie University – QEII Health Science Centre
Nova Scotia, Canada
kirk.magee@dal.ca