Antibiotic and corticosteroid treatment effective for acute exacerbations of COPD

Reference

Dobler CC, Morrow AS, Beuschel B, et al. Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease. A systematic review with meta-analysis. Ann Intern Med 2020;172:413-422. doi:10.7326/M19-3007

Synopsis

These researchers searched several databases, including Cochrane CENTRAL, for English-language randomized controlled trials that evaluated treatments for exacerbations of COPD. Pairs of reviewers selected studies for inclusion, extracted the data, and evaluated the research quality. Based on 68 randomized trials, they found that antibiotic treatment of an acute exacerbation, regardless of severity, doubled the likelihood of resolution by the end of treatment (odds ratio [OR] = 2.03; 95% CI 1.47 - 2.80) and halved the likelihood of treatment failure (OR = .54; .34 - .86), with a moderate strength of evidence. Systemic corticosteroid treatment for 1 day to 56 days was associated with less frequent treatment failure but higher adverse effects, with a low strength of evidence. Current research does not give us good guidance on which antibiotic is best, or the optimum dose or duration of corticosteroid treatment. Other approaches (inhaled corticosteroids, inhaled bronchodilators, various inhaled combinations, aminophylline, magnesium sulfate, and anti-inflammatory treatments) had little or no effect on outcomes. Given the small number of studies for each comparison, the researchers were unable to determine publication bias. They did not find heterogeneity among study results, again due to the small number of studies.