[The efficacy of corticosteroids in exacerbations of chronic obstructive pulmonary disease: meta-analysis of published studies].
BACKGROUND
Corticosteroids are frequently used in exacerbations of chronic obstructive pulmonary disease (COPD), but their efficacy is controversial. We have carried out a systematic review of the literature to clarify this issue.


METHODS
We searched Medline, Cochrane Library and Indice Medico Español databases for articles about corticosteroids and COPD. Placebo-controlled studies were selected and reviewed independently by two investigators.


RESULTS
We found no studies using inhaled corticosteroids. Six studies analysed the effect of systemic corticosteroids. They showed a significant improvement of FEV1 by three days (weighted mean difference between placebo and treated groups 89 ml; CI 25-153; 4 trials) and by 7-14 days (200 ml; CI 7-393; 3 trials). The duration of hospitalisation was also shorter in patients receiving corticosteroids (p = 0.03). There also was a non-statistically significant trend towards a lower failure rate in treated groups, without differences in mortality rate. At midterm, the differences in FEV1 disappeared.


CONCLUSIONS
Corticosteroid administration by systemic route is associated with a clinically relevant short-term improvement in spyrometric values. Although there are no clear differences in prognostic variables, these data give support to the practice of using these drugs for short periods, not longer than two weeks.
Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander. rianchoj@medi.unican.es
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D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004333:Drug Administration Routes; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000188:drug therapy*; D016239:MEDLINE; D013997:Time Factors
D000305:Adrenal Cortex Hormones