Short-term versus longer duration of glucocorticoid therapy for exacerbations of chronic obstructive pulmonary disease - 25/09/16

Systemic glucocorticoid has been shown to improve the outcome of acute exacerbation of chronic obstructive pulmonary disease (COPD). However, the optimal duration remains controversial.

To investigate whether a short-term (seven days or fewer) systemic glucocorticoid treatment in patients with COPD exacerbation is non inferior to longer duration (more than seven days) treatment in clinical outcome.

We searched PubMed, EMBASE, CENTRAL databases, China Clinical Trials, CNKI, The Chinese biomedical literature database (CBM) and wanfang database to identify randomized controlled trials using systemic glucocorticoid in COPD. At least two review authors independently assessed each potentially eligible trial for its inclusion in the review and its quality. Glucocorticoid is given for a period of seven days or fewer versus systemic given for more than seven days. We retrieved time from building to Apr 20, 2016, and supplemented by manual retrieval into literature references. By adopting the combination of keywords and free word retrieval methods, we performed a routine meta-analysis to evaluate the effects of glucocorticoid on FEV₁, FEV₁/FVC, PaO₂, clinical symptoms, relapse, treatment failure, mortality and side-effects between the two treatment groups.

Our search yielded 9 studies involving 874 patients. Six studies were fully published and three were published as abstracts. We obtained data for one study published as abstracts from authors. Short-term treatment varied between three and seven days and longer duration 10–15 days, at equivalent daily doses of glucocorticoid. Mean ages of participants ranged from 60 to 90 years. The FEV₁, FEV₁/FVC, PaO₂ and clinical symptoms between the two treatment groups did not differ significantly by treatment duration. There was no significant difference of relapse, treatment failure, mortality and side-effects between the two treatment groups.

These data show that short-term glucocorticoid is as effective as and possibly safer than longer duration.