title: Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis.
abstract: BACKGROUND
  Systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation (NPPV) are recommended for patients with acute exacerbation of COPD. However, their clinical benefits in various settings are uncertain. We undertook a systematic review and metaanalysis to systematically evaluate the effectiveness of these therapies.
  
  
  METHODS
  MEDLINE and EMBASE were searched to identify relevant randomized controlled clinical trials published from January 1968 to November 2006. We identified additional studies by searching bibliographies of retrieved articles.
  
  
  RESULTS
  Compared with placebo, systemic corticosteroids reduced treatment failure by 46% (95% confidence interval [CI], 0.41 to 0.71), length of hospital stay by 1.4 days (95% CI, 0.7 to 2.2), and improved FEV(1) by 0.13 L after 3 days of therapy (95% CI, 0.04 to 0.21). Meanwhile, the risk of hyperglycemia significantly increased (relative risk, 5.88; 95% CI, 2.40 to 14.41). Compared with placebo, antibiotics reduced treatment failure by 46% (95% CI, 0.32 to 0.92) and in-hospital mortality by 78% (95% CI, 0.08 to 0.62). Compared with standard therapy, NPPV reduced the risk of intubation by 65% (95% CI, 0.26 to 0.47), in-hospital mortality by 55% (95% CI, 0.30 to 0.66), and the length of hospitalization by 1.9 days (95% CI, 0.0 to 3.9).
  
  
  CONCLUSIONS
  For acute COPD exacerbations, systemic corticosteroids are effective in reducing treatment failures, while antibiotics reduce mortality and treatment failures in those requiring hospitalization and NPPV reduces the risk of intubation and in-hospital mortality, especially in those who demonstrate respiratory acidosis.
authors.affiliation: Department of Medicine, Respiratory Division, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Quon
authors.forename: Wen Qi
authors.initials: WQ
authors.lastname: Gan
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018849:Controlled Clinical Trials as Topic; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D011175:Positive-Pressure Respiration / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids