Jay Peters, MD
Are systemic corticosteroids (CSs), antibiotics, and noninvasive positive pressure ventilation (NPPV) effective for acute exacerbations of chronic obstructive pulmonary disease (COPD)?
Studies selected compared CSs, antibiotics, or NPPV with placebo or standard therapy in patients > 19 years of age who had an acute exacerbation of COPD. Studies of patients with asthma, pneumonia, or cardiogenic pulmonary edema were excluded. Outcomes were treatment failure (unchanged or deteriorated symptoms requiring additional treatment at follow-up), need for intubation, in-hospital mortality, and length of hospital stay.
MEDLINE and EMBASE/Excerpta Medica (both 1968 to November 2006), Cochrane Database of Systematic Reviews, and reference lists were searched for randomized controlled trials (RCTs) published in English. 35 RCTs met the selection criteria: 10 RCTs (n = 959, mean age 67 y) evaluated CSs, 11 RCTs (n = 1020, mean age 63 y) evaluated antibiotics, and 14 RCTs (n = 979, mean age 67 y) evaluated NPPV; Jadad scores were ≥ 2.
Meta-analysis showed that CSs reduced treatment failure and length of hospital stay but increased hyperglycemia compared with placebo (Table). Antibiotics reduced treatment failure and in-hospital mortality compared with placebo (Table). NPPV reduced in-hospital mortality, need for intubation, and length of hospital stay compared with standard therapy (Table).
Systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation are effective in acute exacerbations of chronic obstructive pulmonary disease. Antibiotics and NPPV reduce mortality.
Various treatments vs placebo (PLAC) or standard therapy (ST) for acute exacerbations of chronic obstructive pulmonary disease*†
*NPPV = noninvasive positive pressure ventilation; other abbreviations defined in Glossary. Weighted event rates, RRR, RRI, NNT, NNH, and CI calculated from control event rates and relative risks in article using a fixed-effects model.
†Information provided by author.
Peters J. Review: Systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation are effective in acute COPD. Ann Intern Med. 2008;149:JC2–13. doi: 10.7326/0003-4819-149-4-200808190-02013
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Published: Ann Intern Med. 2008;149(4):JC2-13.
Chronic Obstructive Airway Disease, Mechanical Ventilation, Pulmonary/Critical Care.
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