For mild to severe COPD exacerbations, antibiotics and steroids remain the mainstay of treatment

Reference

Dobler CC, Morrow AS, Beuschel B, et al. Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease. Ann Intern Med 2020 Feb 25. doi: 10.7326/M19-3007. [Epub ahead of print]

Synopsis

These investigators searched multiple databases, including EMBASE and MEDLINE, to find randomized controlled trials that evaluated pharmacologic interventions for the treatment of acute COPD exacerbations in the outpatient or inpatient settings. Studies done in the intensive care unit were excluded. Pairs of independent reviewers screened and selected studies for inclusion, extracted data, and assessed study quality. Overall, they included 68 studies involving almost 11,000 participants. Of these, 41 took place in the emergency department or hospital setting. Systemic antibiotics, as compared with placebo or management without antibiotics, led to increased resolution of acute COPD exacerbations, decreased treatment failure, and reduced dyspnea in both outpatients and inpatients, regardless of the severity of the acute episode. Systemic steroids were similarly associated with decreased treatment failure and dyspnea, as compared with placebo or management without steroids. Neither antibiotics nor steroids had an effect on mortality, quality of life, hospital admissions, or recurrent exacerbations. As expected, patients treated with steroids were more likely to have adverse events, especially endocrine-related events. Other pharmacologic interventions, such as aminophylline and magnesium sulfate, had insufficient evidence to support their use.