An updated Cochrane review of randomised clinical trials comparing a short course (≤7 days) with a longer course (7—14 days) of oral or parenteral steroids for severe COPD reinforces existing evidence suggesting that shorter courses can be given when there are concerns about adverse effects. However, the research was limited by small study sizes and including only 582 people in total.
The systematic review and meta-analysis pooled data from eight randomised controlled trials of people with severe or very severe COPD.
All participants had been admitted to hospital; studies with participants requiring assisted ventilation were excluded. The average age was between 65 and 73 years old, and most participants were male. None of the studies were from the UK.
Moderately reliable evidence
Overall, the evidence was graded as moderate in reliability because of the small sample size and wide range of results. The five studies used in the main analysis (n=519) were considered to be at low risk of bias. The reviewers noted that the inclusion of a new, well-conducted study of 296 people, published since the evidence was last reviewed in 2011, increased their confidence in the results.
There was no significant difference in the likelihood of treatment failure (need for additional treatment) between the short and longer course of steroids (odds ratio [OR] 0.72, 95% CI 0.36—1.46; four studies, 457 participants), although the authors highlight the uncertainty indicated by the wide confidence interval.
There was also no difference between treatments in the likelihood of people experiencing a new exacerbation during the 14 to 180 days of follow-up (OR 1.04, 95% CI 0.7—1.56; four studies, 457 participants).
Two studies with moderate-quality data showed no difference in the likelihood of developing hyperglycaemia between treatment durations (OR 0.99, 95% CI 0.64—1.53; 345 people). Low-quality data from five studies also showed no difference in a range of other adverse effects (OR 0.89, 95% CI 0.46—1.69; 503 people).
'This review suggests that the likelihood is low that shorter courses of systemic corticosteroids (of around five days) lead to worse outcomes than are seen with longer (10 to 14 days) courses,' concluded the authors.
NICE guidance on managing COPD published in 2010 advises that exacerbations be treated with oral corticosteroids for no longer than 14 days.