The efficacy of corticosteroids in exacerbations of chronic obstructive pulmonary disease: meta-analysis of published studies

BACKGROUND: Corticosteroids are frequently used in exacerbations of chronic obstructive pulmonary disease (COPD), but their efficacy is controversial. We have carried out a systematic review of the literature to clarify this issue. METHODS: We searched Medline, Cochrane Library and Indice Medico Espanol da tabases for articles about corticosteroids and COPD. Placebo-controlled stu dies were selected and reviewed independently by two investigators, RESULTS: We found no studies using inhaled corticosteroids, Six studies ana lysed the effect of systemic corticosteroids. They showed a significant imp rovement of FEV1 by three days (weighted mean difference between placebo an d treated groups 89 ml; Cl 25-153; 4 trials) and by 7-14 days (200 ml; Cl 7 -393; 3 trials), The duration of hospitalisation was also shorter in patien ts receiving corticosteroids (p = 0.03). There also was a non-statistically significant trend towards a lower failure rate in treated groups, without differences in mortality rate. At midterm, the differences in FEV1 disappea red. CONCLUSION: Corticosteroid administration by systemic route is associated w ith a clinically relevant short-term improvement in spyrometric values. Alt hough there are no clear differences in prognostic variables, these data gi ve support to the practice of using these drugs for short periods, not long er than two weeks.