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Clin Respir J. 2013 Oct;7(4):305-18. doi: 10.1111/crj.12008. Epub 2012 Nov 28.

Systemic corticosteroid for COPD exacerbations, whether the higher dose is better? A meta-analysis of randomized controlled trials.

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  • 1Department of Pulmonary Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Abstract

BACKGROUND:

Systemic corticosteroids (SCS) have been shown to improve the outcome of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, the optimal dose remains controversial.

OBJECTIVES:

We performed a meta-analysis to evaluate whether high-dose SCS is better.

METHODS:

We searched PubMed, EMBASE, CPCI-S and CENTRAL databases, and references of reviews or meta-analyses to identify randomized controlled trials using SCS in AECOPD. We performed a routine meta-analysis to evaluate the effects of SCS on treatment failure rate and forced expiratory volume in 1 s (FEV1) improvement compared with placebo in AECOPD. Subgroup analysis was performed by dividing the studies into a high-dose group [initial dose ≥80 mg prednisone equivalent (PE)/day] and a low-dose group (initial dose 30-80 mg PE/day) in all patients and in only inpatients. Meta-regression was performed using initial dose as an independent factor. We classified the suspected adverse effects into several groups and combined them separately.

RESULTS:

Our search yielded 12 studies involving 1172 patients. SCS use was associated with a significant reduction in the treatment failure rate [risk ratio 0.58; 95% confidence interval (CI): 0.46-0.73] and improvement in ▵FEV1 (0.11 L; 95% CI: 0.08-0.14 L). The high-dose regimen did not show superiority to the low-dose regimen. No obvious correlation was found between the SCS effect and the initial dose. SCS led to an obvious increase in hyperglycemia risk. However, the high-dose group did not show obviously higher risk of adverse effects.

CONCLUSION:

SCS can reduce treatment failure rate and improve lung function in AECOPD. The low-dose regimen (initial dose 30-80 mg/day PE) is proper for treating AECOPD.

KEYWORDS:

Chronic Obstructive Pulmonary Disease (COPD); acute exacerbation of chronic obstructive pulmonary disease (AECOPD); administration and dosage; glucocorticoids; meta-analysis

PMID:
23072733
DOI:
10.1111/crj.12008
[PubMed - indexed for MEDLINE]
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