464 Short courses of systemic steroids effective in severe chronic obstructive pulmonary disease

August 02, 2015

written by Brian R McAvoy.

Clinical question
How effective are short (7 or fewer days) compared with longer (more than 7 days) courses of systemic corticosteroids for exacerbations of chronic obstructive pulmonary disease (COPD)?

Bottom line
People treated with short courses did not have a higher rate of treatment failure or longer time to their next exacerbation. Times in hospital and lung function at the end of treatment were not different. No differences in side effects or death were noted between treatments. Information on quality of life was limited, as only 1 study measured it.

The studies did not include people with mild or moderate COPD. Most evidence was graded as having moderate quality as the result of imprecision. For example, many studies did not provide details of their inclusion criteria, including their definition of an acute exacerbation of COPD, and duration of follow-up varied between studies and was not stated in 4 studies.

Current guidelines recommend patients with acute exacerbations of COPD should be treated with systemic corticosteroids for 7-14 days. Intermittent systemic corticosteroid use is cumulatively associated with adverse effects such as osteoporosis, hyperglycaemia and muscle weakness. Shorter treatment could reduce adverse effects.

Cochrane Systematic Review
Walters JAE et al. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease. Cochrane Reviews, 2014, Issue 12. Art. No.: CD006897.DOI: 10.1002/14651858. CD006897.pub3. This review contains 8 studies involving 582 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.