DOI: 10.1097/01.ccm.0000458192.95798.3e
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Issn Print: 0090-3493
Publication Date: 2014/12/01
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Excerpt
Methods: Two independent reviewers systematically searched “Pubmed”, “Embase”, “Cochrane” and “Chinese database” using the meSH word “chronic obstructive pulmonary disease”, “corticosteroids”, “prednisone” and “budesonide” through June 2014. Additionally conference abstracts, review articles and bibliographies were searched. Randomized controlled trials were included if those were done on AECOPD patients and compared systemic corticosteroids(IV/PO) with inhaled steroids. All the studies excluded patients admitted to intensive care unit or in respiratory failure requiring mechanical ventilation. Primary end points were exacerbations and rehospitalization rates in next 30 days. Secondary end point was serious adverse events (death, life-threatening events, and events resulting in prolongation of hospitalization throughout the study period) during hospital stay.
Results: Thirteen randomized controlled trials were found. Out of thirteen studies, only three studies including 250 patients reported primary end points. Overall, 12.8% patients had exacerbations in inhaled corticosteroids group compared to 8.8% in systemic corticosteroids group. There was no significant difference in exacerbations rate between two groups (odds ratio[OR], 1.51; 95% CI, 0.66 to 3.47, I2=0%). Similarly, rehospitalization rates were also not different (odds ratio[OR], 1.84; 95% CI, 0.68 to 5.00, I2=0%) between two groups. Only two studies reported serious adverse events. The risk for serious adverse events were not different among two groups (odds ratio[OR], 1.39; 95% CI, 0.47 to 4.09, I2=0%).
Conclusions: Inhaled corticosteroids may be an effective and safe alternative to systemic corticosteroids in AECOPD.
