Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysis

Claudia C Dobler, Allison S Morrow, Bradley Beuschel, Magdoleen H Farah, Abdul M Majzoub, Michael E Wilson, Bashar Hasan, Mohamed O Seisa, Lubna Daraz, Larry J Prokop, M Hassan Murad, Zhen Wang

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is characterized by frequent exacerbations.

Purpose: To evaluate the comparative effectiveness and adverse events (AEs) of pharmacologic interventions for adults with exacerbation of COPD.

Data Sources: English-language searches of several bibliographic sources from database inception to 2 January 2019.

Study Selection: 68 randomized controlled trials that enrolled adults with exacerbation of COPD treated in out- or inpatient settings other than intensive care and compared pharmacologic therapies with placebo, "usual care," or other pharmacologic interventions.

Data Extraction: Two reviewers independently extracted data and rated study quality and strength of evidence (SOE).

Data Synthesis: Compared with placebo or management without antibiotics, antibiotics given for 3 to 14 days were associated with increased exacerbation resolution at the end of the intervention (odds ratio [OR], 2.03 [95% CI, 1.47 to 2.80]; moderate SOE) and less treatment failure at the end of the intervention (OR, 0.54 [CI, 0.34 to 0.86]; moderate SOE), independent of severity of exacerbations in out- and inpatients. Compared with placebo in out- and inpatients, systemic corticosteroids given for 9 to 56 days were associated with less treatment failure at the end of the intervention (OR, 0.01 [CI, 0.00 to 0.13]; low SOE) but also with a higher number of total and endocrine-related AEs. Compared with placebo or usual care in inpatients, other pharmacologic interventions (aminophyllines, magnesium sulfate, anti-inflammatory agents, inhaled corticosteroids, and short-acting bronchodilators) had insufficient evidence, showing either no or inconclusive effects (with the exception of the mucolytic erdosteine) or improvement only in lung function.

Limitation: Scant evidence for many interventions; several studies had unclear or high risk of bias and inadequate reporting of AEs.

Conclusion: Antibiotics and systemic corticosteroids reduce treatment failure in adults with mild to severe exacerbation of COPD.

Primary Funding Source: Agency for Healthcare Research and Quality. (PROSPERO: CRD42018111609).

Original languageEnglish
Pages (from-to)413-422
Number of pages10
JournalAnnals of Internal Medicine
Volume172
Issue number6
Early online date25 Feb 2020
DOIs
Publication statusPublished - 17 Mar 2020

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    Dobler, C. C., Morrow, A. S., Beuschel, B., Farah, M. H., Majzoub, A. M., Wilson, M. E., Hasan, B., Seisa, M. O., Daraz, L., Prokop, L. J., Murad, M. H., & Wang, Z. (2020). Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review With Meta-analysis. Annals of Internal Medicine, 172(6), 413-422. https://doi.org/10.7326/M19-3007