Short-Term Corticosteroids Sufficient in Acute COPD Exacerbations

Patients with acute chronic obstructive pulmonary disease (COPD) exacerbations can benefit from short-term corticosteroid therapy (<7 days), as they have similar risk for treatment failure, relapse, and medication side effects compared with long-term corticosteroid therapy, according to a review of a Cochrane Database Systematic Review¹ meta-analysis published in Annals of Emergency Medicine.²

Researchers of the meta-analysis sought to investigate the differences between short-term and long-term corticosteroid treatments in patients with acute COPD exacerbations by conducting a meta-analysis of primary outcomes (treatment failure, relapse, and adverse medication effects) from 8 randomized controlled trials.

A total of 582 patients with a mean age of 65 to 73 years, and the trials were composed mostly of men were included. Short-term therapy was indicated for 3, 5, or 7 days, and long-term therapy was indicated for 10, 14, or 15 days. Of the 8 randomized controlled trials, 5 used oral prednisolone and 3 used intravenous systemic corticosteroids. The likelihood of treatment failure, relapse, or a patient experiencing adverse effects from medication was compared between short and long therapy durations, as were results of mortality, hospitalization, lung function, arterial blood gas components, disease symptoms, and quality of life.

In comparing short-term and long-term corticosteroid use, there was no difference in the risk for treatment failure, relapse, or adverse effects from medication. In addition, the secondary outcomes did not differ between the treatment durations, including mortality, length of hospitalization, lung function, arterial blood gas measures, symptoms scores, and quality of life assessments.

Limitations of the meta-analysis included a small sample size and the need to exclude 3 studies due to unavailable data. Another limitation is that the studies that had only been published as abstracts, which meant that the researchers were unable to appraise any methodological flaws, biases, or quality issues. In addition, patients with mild or moderate COPD were not included, nor were patients who required assisted ventilation. Furthermore, information regarding inclusion criteria was narrow or inadequate.

The authors of the review suggested that short-term corticosteroids are sufficient for treating patients with COPD exacerbations. Further studies are needed to assess the efficacy of short-term corticosteroids on mild or moderate COPD.

References

1. Walters JAE, Tan DJ, White CJ, Wood-Baker R. Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease (review). Cochrane Database Syst Rev. 2018;3:CD006897
2. Long B, April MD. Are shorter courses of corticosteroids as effective as longer courses in acute exacerbations of chronic obstructive pulmonary disease? [published online July 18, 2018]. Ann Emerg Med. doi:10.1016/j.annemergmed.2018.05.008