Systemic corticosteroid forCOPDexacerbations, whether the higher dose is better? A meta‐analysis of randomized controlled trials

Abstract

SCS can reduce treatment failure rate and improve lung function in AECOPD. The low-dose regimen (initial dose 30-80 mg/day PE) is proper for treating AECOPD.

Prednisone in COPD exacerbation requiring ventilatory support: an open-label randomised evaluation

“…However, issues like steroid daily dose, the route of administration and the course duration are poorly standardised in the treatment of COPD exacerbation. Different doses (low initial dose versus higher doses) [18], route of administration (by mouth or intravenously) [25,26] and course duration (3 days, 7 days or even beyond) [27] have been used in previous studies, and little, if any, evidence suggests that these parameters could have a drastic impact on steroids efficacy. For the particular issue of initial steroid dose, a meta-analytic comparison of high initial dose (i.e.…”

“…For the particular issue of initial steroid dose, a meta-analytic comparison of high initial dose (i.e. o80 mg prednisone equivalent dose) and low initial dose of systemic steroids showed no superiority of the high-dose regime over the low-dose regime [18]. With regard to these considerations, we do not see a major design difference between our study and that of ALIA et al [21], and potential causes of differences, including the effect on NIV failure, must be sought elsewhere.…”

“…Indeed, although data are insufficient to define the optimal dose, route or duration of systemic corticosteroids, current guidelines strongly recommend administration of systemic steroids (prednisone equivalent doses of 30-40 mg?day -1 ) to hospitalised patients with AECOPD [1,14,15]. Recommendations rely on meta-analyses with cumulated effects showing both a significant reduction in the rate of treatment failure, and an increase in the rate of improvement in lung function and dyspnoea [16][17][18]. However, systemic corticosteroids were not associated with a reduction in the mortality rate, and induced a significant increase in adverse effects (in particular a five-fold increase in hyperglycaemic episodes) [17,18].…”

“…Recommendations rely on meta-analyses with cumulated effects showing both a significant reduction in the rate of treatment failure, and an increase in the rate of improvement in lung function and dyspnoea [16][17][18]. However, systemic corticosteroids were not associated with a reduction in the mortality rate, and induced a significant increase in adverse effects (in particular a five-fold increase in hyperglycaemic episodes) [17,18]. Moreover, primary studies included in these meta-analyses usually excluded COPD patients with an exacerbation severe enough to require ventilatory support in the intensive care unit (ICU).…”

Antibacterial treatment of moderate chronic obstructive pulmonary disease exacerbation

“…В случае обострения, сопро вождающегося выраженным снижением ОФВ1 и прогрессированием одышки, наряду с АМП, эф фективно и безопасно назначение системных корти костероидов (преднизолон в дозе 30-80 мг в сутки в течение 7-14 суток [13][14][15][16][17][18]). …”