Systemic Corticosteroids for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SUNHu ¹ , ZUOLei ¹ , YEYuanzheng ² , LIChao ¹ , ZHANGYing ³ , XUSicheng ¹ ,  Baihetinisha-tuerdi ¹

1. Department of Respiratory Intensive Care Unit, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R.China;
2. Department of Heart Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R.China;
3. Department of Pneumology Department, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, P.R.China;

Corresponding author：

Baihetinisha-tuerdi, Email: 1627971002@qq.com

Keywords：

Chronic obstructive pulmonary disease; Corticosteroids; Systematic review; Meta-analysis

DOI：

10.7507/1671-6205.201607019

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Objective To systematically evaluate the effect and safety of systemic corticosteroids for acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 6, 2015), Wanfang Data, CBM, CNKI were searched to collect randomized controlled trails (RCTs) about systemic corticosteroids for acute exacerbation of COPD from inception to July 2015. The meta-analysis was conducted using RevMan 5.3 software. Results A total of 11 RCTs involving 1298 patients were included. The results of meta-analysis showed that a statistically significant increase in the treatment success rate when using systemic corticosteroids (RR=1.11, 95%CI 1.01-1.21,P=0.02), and a non-significant difference of effect in the subgroup of emergency department and ICU patients (RR=0.98, 95%CI 0.90-1.08,P=0.74;RR=1.19, 95%CI 0.84-1.69,P=0.34). Conclusions Current studies suggest that systemic corticosteroids is beneficial in terms of treatment success rate, but subgroup analysis shows that this benefit is controversial in emergency department and ICU. however, due to the limited quantity of the included studies, the above conclusions still need more high quality research to be verified.

Citation： SUNHu, ZUOLei, YEYuanzheng, LIChao, ZHANGYing, XUSicheng, Baihetinisha-tuerdi. Systemic Corticosteroids for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(1): 1-8. doi: 10.7507/1671-6205.201607019 Copy

1.	Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2013, 380(9859): 2095-2128.
2.	Guarascio AJ, Ray SM, Finch CK, et al. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res, 2013, 5: 235-245.
3.	Celli BR, MacNee W, Agusti A, et al. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J, 2004, 23(6): 932-946.
4.	Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of Acute Exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest, 2015, 147(4): 894-942.
5.	Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1999, 340(25): 1941-1947.
6.	Lindenauer PK, Pekow PS, Lahti MC, et al. Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease. JAMA, 2010, 303(23): 2359-2367.
7.	Anthonisen NR, Manfreda J, Warren CPW, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med, 1987, 106(2): 196-204.
8.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at: www.cochrane-handbook.org.
9.	Aaron SD, Vandemheen KL, Hebert P, et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med, 2003, 348(26): 2618-2625.
10.	Abroug F, Ouanes-Besbes L, Fkih-Hassen M, et al. Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation. Eur Respir J, 2014, 43(3): 717-724.
11.	Albert RK, Martin TR, Lewis SW. Controlled clinical trial of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency. Ann Intern Med, 1980, 92(6): 753-758.
12.	Alía I, Miguel A, Esteban A, et al. Efficacy of corticosteroid therapy in patients with an acute exacerbation of chronic obstructive pulmonary disease receiving ventilatory support. Arch Intern Med, 2011, 171(21): 1939-1946.
13.	Bullard MJ, Liaw SJ, Tsai YH, et al. Early corticosteroid use in acute exacerbations of chronic airflow obstruction. Am J Emerg Med, 1996, 14(2): 139-143.
14.	Davies L, Angus RM, Calverley PMA. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet, 1999, 354(9177): 456-460.
15.	Emerman CL, Connors AF, Lukens TW, et al. A randomized controlled trial of methylprednisolone in the emergency treatment of acute exacerbations of COPD. Chest, 1989, 95(3): 563-567.
16.	Maltais F, Ostinelli J, Bourbeau J, et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med, 2002, 165(5): 698-703.
17.	Thompson WH, Nielson CP, Carvalho P, et al. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am J Respir Crit Care Med, 1996, 154(2): 407-412.
18.	陈钢, 谢灿茂, 罗益峰, 等. 口服糖皮质激素治疗慢性阻塞性肺疾病急性加重的疗效和疗程研究.中华结核和呼吸杂志, 2008, 31(8): 577-580.
19.	Halbert RJ, Natoli JL, Gano A, et al. Global burden of COPD: systematic review and meta-analysis. Eur Respir J, 2006, 28(3): 523-532.
20.
21.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版).中华结核和呼吸杂志, 2013, 36(4): 255-264.

1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2013, 380(9859): 2095-2128.
2. Guarascio AJ, Ray SM, Finch CK, et al. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res, 2013, 5: 235-245.
3. Celli BR, MacNee W, Agusti A, et al. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J, 2004, 23(6): 932-946.
4. Criner GJ, Bourbeau J, Diekemper RL, et al. Prevention of Acute Exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline. Chest, 2015, 147(4): 894-942.
5. Niewoehner DE, Erbland ML, Deupree RH, et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. N Engl J Med, 1999, 340(25): 1941-1947.
6. Lindenauer PK, Pekow PS, Lahti MC, et al. Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease. JAMA, 2010, 303(23): 2359-2367.
7. Anthonisen NR, Manfreda J, Warren CPW, et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med, 1987, 106(2): 196-204.
8. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at: www.cochrane-handbook.org.
9. Aaron SD, Vandemheen KL, Hebert P, et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med, 2003, 348(26): 2618-2625.
10. Abroug F, Ouanes-Besbes L, Fkih-Hassen M, et al. Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation. Eur Respir J, 2014, 43(3): 717-724.
11. Albert RK, Martin TR, Lewis SW. Controlled clinical trial of methylprednisolone in patients with chronic bronchitis and acute respiratory insufficiency. Ann Intern Med, 1980, 92(6): 753-758.
12. Alía I, Miguel A, Esteban A, et al. Efficacy of corticosteroid therapy in patients with an acute exacerbation of chronic obstructive pulmonary disease receiving ventilatory support. Arch Intern Med, 2011, 171(21): 1939-1946.
13. Bullard MJ, Liaw SJ, Tsai YH, et al. Early corticosteroid use in acute exacerbations of chronic airflow obstruction. Am J Emerg Med, 1996, 14(2): 139-143.
14. Davies L, Angus RM, Calverley PMA. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet, 1999, 354(9177): 456-460.
15. Emerman CL, Connors AF, Lukens TW, et al. A randomized controlled trial of methylprednisolone in the emergency treatment of acute exacerbations of COPD. Chest, 1989, 95(3): 563-567.
16. Maltais F, Ostinelli J, Bourbeau J, et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Am J Respir Crit Care Med, 2002, 165(5): 698-703.
17. Thompson WH, Nielson CP, Carvalho P, et al. Controlled trial of oral prednisone in outpatients with acute COPD exacerbation. Am J Respir Crit Care Med, 1996, 154(2): 407-412.
18. 陈钢, 谢灿茂, 罗益峰, 等. 口服糖皮质激素治疗慢性阻塞性肺疾病急性加重的疗效和疗程研究.中华结核和呼吸杂志, 2008, 31(8): 577-580.
19. Halbert RJ, Natoli JL, Gano A, et al. Global burden of COPD: systematic review and meta-analysis. Eur Respir J, 2006, 28(3): 523-532.
20.
21. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013 年修订版).中华结核和呼吸杂志, 2013, 36(4): 255-264.

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Systemic Corticosteroids for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

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