Review Affirms Effectiveness of Antibiotics, Steroids in Treating Chronic Obstructive Pulmonary Disease

For patients with chronic obstructive pulmonary disease (COPD), antibiotics and steroids are effective in treating both mild and severe episodes of symptom flare-ups, according to an AHRQ-funded systematic review. Authors noted that uncertainty has persisted about whether COPD patients experiencing mild flare-ups—referred to as exacerbations—benefitted from antibiotics and steroids. Their research review showed that two treatment regimens—antibiotics given over a three- to 14-day period and steroids given for nine to 56 days—were associated with improved breathing in mild to severe cases. The review consisted of 68 randomized controlled trials comprising nearly 10,800 adults. Access the abstract of the review, published in Annals of Internal Medicine.

Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysis

Affiliations

PMID: 32092762
DOI: 10.7326/M19-3007

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by frequent exacerbations.

Purpose: To evaluate the comparative effectiveness and adverse events (AEs) of pharmacologic interventions for adults with exacerbation of COPD.

Data sources: English-language searches of several bibliographic sources from database inception to 2 January 2019.

Study selection: 68 randomized controlled trials that enrolled adults with exacerbation of COPD treated in out- or inpatient settings other than intensive care and compared pharmacologic therapies with placebo, "usual care," or other pharmacologic interventions.

Data extraction: Two reviewers independently extracted data and rated study quality and strength of evidence (SOE).

Data synthesis: Compared with placebo or management without antibiotics, antibiotics given for 3 to 14 days were associated with increased exacerbation resolution at the end of the intervention (odds ratio [OR], 2.03 [95% CI, 1.47 to 2.80]; moderate SOE) and less treatment failure at the end of the intervention (OR, 0.54 [CI, 0.34 to 0.86]; moderate SOE), independent of severity of exacerbations in out- and inpatients. Compared with placebo in out- and inpatients, systemic corticosteroids given for 9 to 56 days were associated with less treatment failure at the end of the intervention (OR, 0.01 [CI, 0.00 to 0.13]; low SOE) but also with a higher number of total and endocrine-related AEs. Compared with placebo or usual care in inpatients, other pharmacologic interventions (aminophyllines, magnesium sulfate, anti-inflammatory agents, inhaled corticosteroids, and short-acting bronchodilators) had insufficient evidence, showing either no or inconclusive effects (with the exception of the mucolytic erdosteine) or improvement only in lung function.

Limitation: Scant evidence for many interventions; several studies had unclear or high risk of bias and inadequate reporting of AEs.

Conclusion: Antibiotics and systemic corticosteroids reduce treatment failure in adults with mild to severe exacerbation of COPD.

Primary funding source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42018111609).