Chronic obstructive pulmonary disease (COPD), also known as emphysema or chronic bronchitis, is a chronic disease affecting the lungs, most often as a result of smoking. People with COPD may have episodes of deterioration that involve a worsening of their symptoms, known as acute exacerbations, which may require admission to hospital. Symptoms of an exacerbation of COPD include increased breathlessness, increased sputum or phlegm production, and increased sputum volume. These exacerbations are mostly caused by infections that result in inflammation of the airways.
Treatment of these exacerbations with corticosteroids, such as prednisolone, prednisone or cortisone, has become standard. A previous review has shown that the use of corticosteroids is beneficial and improves symptoms and lung function, shortens hospital stays and reduces the need to seek extra medical attention. Side effects of corticosteroid use can include raised blood glucose, decreased bone density, increased risk of fractures and muscle weakness. Prior to the current review there was no consensus on the duration of corticosteroid treatment. This review analysed the results from studies that compared participants with acute exacerbations who received corticosteroids for seven days or fewer with participants who received corticosteroids for more than seven days.
Seven studies were included in the analysis and in total there were 288 participants. The main findings of this review were that there were no significant differences in treatment failure (when extra medical attention is required) or lung function in people who received corticosteroids for seven days or fewer compared with those who received treatment for more than seven days. There is not enough information available to be sure whether shorter courses of corticosteroids are just as good as longer courses.
Adverse effects of the use of corticosteroids were reported in four of the studies (involving 102 patients) and overall there was no significant difference in the likelihood of a side effect between the shorter or longer treatment courses.
The analysis was limited by the fact that data for three studies that were published only as abstracts were unavailable. Further studies would be beneficial to add to this review; however, recruitment to such studies could be difficult as many patients with acute exacerbations will have received systemic corticosteroids prior to recruitment.