Plain language summary
Are shorter courses of systemic steroids as effective as conventional longer courses in the treatment of patients with flare-ups of COPD?
Why is this question important?
Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, is a long-term lung condition that is commonly associated with smoking. Patients with COPD may experience flare-ups (exacerbations), often precipitated by infection, in which symptoms such as breathlessness, cough and phlegm become markedly worse, and extra treatment or admission to hospital is required.
Systemic (i.e. not inhaled) corticosteroids, such as prednisolone, prednisone and cortisone, are commonly used in the treatment of patients with these flare-ups (exacerbations). We wanted to assess whether a shorter course (seven or fewer days) of this treatment was as good as a course of usual length (longer than seven days) and caused fewer side effects.
How did we answer the question?
We looked for all studies that compared oral or injected corticosteroid treatment given for seven or fewer days versus treatment given for longer than seven days in people with acute exacerbations of COPD.
What did we find?
We found eight studies that included 582 people with COPD who experienced a flare-up that required extra treatment in hospital. These studies compared oral or injected corticosteroid treatment given for seven or fewer days versus treatment for longer than seven days. Most of the people in these studies were in their late sixties and had severe or very severe symptoms of COPD; more men than women took part. The last search for studies to be included in the review was conducted in March 2017.
No differences were observed between shorter and longer courses of treatment. People treated for seven or fewer days did not have a higher rate of treatment failure or longer time to their next exacerbation; the number of people who avoided treatment failure ranged from 51 fewer to 34 more per 1000 treated (average 22 fewer people per 1000). Time in hospital and lung function (blowing tests) at the end of treatment were not different. No differences in side effects or death were noted between treatments. Information on quality of life, which is an important outcome for people with COPD, is limited, as only one study measured it.
The eight studies included in this review were generally well designed, and the quality of the evidence was rated as moderate because of imprecision in results; more research, especially involving people with less severe COPD, is needed.