Evaluating Current Approaches to Exacerbations of COPD

John G. Bartlett, MD


March 26, 2009

Contemporary Management of Acute Exacerbations of COPD: A Systematic Review and Metaanalysis

This meta-analysis examined the value of current practice with systemic corticosteroids, antibiotics, and noninvasive positive pressure ventilation (NPPV) in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD).

Quon BS, Gan WQ, Sin DD
Chest. 2008;133:756-766

Article Summary

The authors conducted a meta-analysis that compared the use of systemic corticosteroids, antibiotics, or NPPV vs placebo or standard treatment in adults with acute exacerbations of COPD. Patients with pneumonia, pulmonary edema, or asthma were excluded. Outcome was based on treatment failure, need for intubation, mortality, and length of stay. The review covered the literature from 1968 to 2006.

The authors accepted a total of 35 reviews: 10 evaluated steroids; 11 evaluated antibiotics; and 14 evaluated NPPV.

Selected results from the study are summarized in the following Table .

The authors concluded that these results support the use of systemic corticosteroids, antibiotics, and possibly NPPV.


This review addressed some of the most controversial areas in management of acute exacerbations of chronic bronchitis. Dr. Jay Peters reviewed the analysis in the ACP Journal Club,[1] concluding that this was "an excellent meta-analysis" but "several caveats exist for interpretation." He noted that the role of antibiotics remains controversial because of the small number of recent studies. The overall impression is that the data support oral corticosteroids (30-40 mg/day for 5-14 days) and that antibiotics are usually given, but still need proper study in terms of choice of agent and duration of treatment.



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