Systemic steroids administered to patients with AECOPD reduce treatment failure, shorten hospital length of stay, improve lung function, and reduce dyspnea. 2 However, observational evidence suggests that high-dose systemic steroids (., the usual clinical practice 5 ) are associated with worse clinical outcomes than low-dose systemic steroids. 2-4 A potential explanation for this observation is that the undesirable effects of systemic steroids are probably more common or more severe when higher doses are used, including hyperglycemia, delirium, fluid retention, muscle weakness, infection, and other side effects.
Narrative: Chronic obstructive pulmonary disease (COPD), a term that encompasses both patients diagnosed with chronic bronchitis and emphysema, is an obstructive lung disease in many cases caused by years of tobacco smoking. It is thought that patients with COPD ‘exacerbation’ (increased shortness of breath or change in their chronic cough and sputum) may benefit from steroids, presumably by reducing the inflammatory response that accompanies the exacerbation.
Benefits: 10 studies contributed data for this Cochrane analysis, representing 1051 patients. There was no statistically significant difference in the mortality of subjects who received systemic steroids compared to placebo. In regards to treatment failure, the review found a NNT of 10 (% reduction). Interestingly, no benefit was found in analysis of studies with steroids for less than 72 hours. The reductions in treatment failure were recorded from studies including both admitted and outpatient/Emergency Department patients.
Harms: Corticosteroids can cause multiple side effects, and some studies evaluated harms, though this was inconsistent across studies. When harms were pooled, there was an absolute risk increase of % for patients receiving steroids (NNH = 7) though this includes some harms that are not patient-oriented (high blood sugars) as well as some that are patient-oriented (diarrhea).
In a 3-week crossover, randomised, placebo-controlled clinical study Eklira Genuair was associated with a statistically significant improvement in exercise endurance time in comparison to placebo of 58 seconds (95% CI=9-108; p=; pre-treatment value: 486 seconds). Eklira Genuair statistically significantly reduced lung hyperinflation at rest (functional residual capacity [FRC]= L [95% CI=, ; p=]; residual volume [RV]= L [95% CI=, ; p=]) and also improved trough inspiratory capacity (by L; 95% CI=, ; p=) and reduced dyspnoea during exercise (Borg scale) (by Borg units; 95% CI=, ; p=).