Systemic corticosteroids for acute exacerbations of chronic obstructive pulmonary disease.The administration of systemic corticosteroids for patients with exacerbations of ciclo winstrol stanozolol comprimido obstructive pulmonary disease COPD has become common practice over the past 25 years. This practice remained somewhat controversial because corticosteroids can have serious adverse effects and initial clinical trials provided inconclusive evidence concerning obbstructive efficacy. Results from recent clinical trials indicate that systemic corticosteroids are modestly effective in shortening the duration of severe exacerbations of COPD. Oral corticosteroids probably confer similar benefits when used for treating moderately severe COPD exacerbations in an out-patient setting. The exacerbatioh starting dose of corticosteroids is not known, but the duration of treatment should not extend longer than 2 weeks.
Acute exacerbations of chronic obstructive pulmonary disease COPD are a major cause of hospital admission and mortality.
They contribute to long-term decline in lung function, physical capacity and quality of life. The most common causes are infective, and treatment includes antibiotics, bronchodilators and systemic corticosteroids as anti-inflammatory agents.
To assess the effects of corticosteroids administered orally or parenterally for treatment of acute exacerbations of COPD, and to compare the efficacy of parenteral versus oral administration. We conducted the last search in May Randomised controlled trials comparing corticosteroids administered orally or parenterally with an appropriate placebo, or comparing oral corticosteroids with parenteral corticosteroids in the treatment of people with acute exacerbations of COPD.
We excluded clinical studies of acute asthma. We judged risk of selection, detection, attrition and reporting bias as low or unclear in all studies. We judged risk of performance bias high in one study comparing systemic corticosteroid with control and in two studies comparing intravenous corticosteroid versus oral corticosteroid. The likelihood of adverse events increased with corticosteroid treatment OR 2.
The risk of hyperglycaemia was significantly increased OR 2. For general inpatient treatment, duration of hospitalisation was significantly shorter with corticosteroid treatment MD Comparison of parenteral versus oral treatment showed no significant difference in the primary outcomes of treatment failure, relapse or mortality or for any secondary outcomes.
There was a significantly increased rate of hyperglycaemia in one study OR 4. There is high-quality evidence to support treatment of exacerbations of COPD with systemic corticosteroid by the oral or parenteral route in reducing the likelihood of treatment failure and relapse by one month, shortening length of stay in hospital inpatients not requiring assisted ventilation in ICU and giving earlier improvement in lung function and symptoms.
There is no evidence of benefit for parenteral treatment compared with oral treatment with corticosteroid on treatment failure, relapse or mortality. There is an increase in adverse drug effects with corticosteroid treatment, which is greater with parenteral administration compared with oral treatment. National Center for Biotechnology Information , U.
Didn't get the message? Add to My Bibliography. Generate a file for use with external citation management software. Cochrane Database Syst Rev. We used standard methodological procedures expected by The Cochrane Collaboration.