Efficacy Endpoints: Mortality, Treatment Failure (Lack of resolution, worsening, or death)
Harm Endpoints: Adverse Drug Effects
Narrative: Chronic obstructive pulmonary disease (COPD), a term that encompasses both patients diagnosed with chronic bronchitis and emphysema, is an obstructive lung disease in many cases caused by years of tobacco smoking. It is thought that patients with COPD ‘exacerbation’ (increased shortness of breath or change in their chronic cough and sputum) may benefit from steroids, presumably by reducing the inflammatory response that accompanies the exacerbation.
Benefits: 10 studies contributed data for this Cochrane analysis, representing 1051 patients. There was no statistically significant difference in the mortality of subjects who received systemic steroids compared to placebo. In regards to treatment failure, the review found a NNT of 10 (10.5% reduction). Interestingly, no benefit was found in analysis of studies with steroids for less than 72 hours. The reductions in treatment failure were recorded from studies including both admitted and outpatient/Emergency Department patients.
Harms: Corticosteroids can cause multiple side effects, and some studies evaluated harms, though this was inconsistent across studies. When harms were pooled, there was an absolute risk increase of 13.9% for patients receiving steroids (NNH = 7) though this includes some harms that are not patient-oriented (high blood sugars) as well as some that are patient-oriented (diarrhea).
Caveats: While IV and oral doses of corticosteroids typically have similar potency and effect, the studies included in this review used varying doses, durations, and tapering regimens. Also, definitions of COPD and COPD exacerbation varied between trials, suggesting possible heterogeneity of the populations studied.
Author: Graham Walker, MD
Published/Updated: August 19, 2010
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