Table 1 Patients characteristics and steroid regimen in the studies included in the meta-analysis
Study and publication year | Setting | Exacerbation criteria | Mean age (SD) | Patient number | Intervention | Duration (days) | Endpoint and success criteria | Jadad score | |
|---|---|---|---|---|---|---|---|---|---|
Systemic corticosteroids (n/N) | Controls (n/N) | ||||||||
Albert 1980 [29] | Pulmonology ward | Clinical and pulmonary function | 61.5 ± 9.5 | 22/44 | 22/44 | Methylprednisolone IV 0.5 mg/kg/6 h ± 72 h | 3 | Improvement in lung function | 5 |
Emerman 1989 [28] | ED | Clinical and pulmonary function | 64.0 ± 7.8 | 52/96 | 44/96 | Methylprednisolone IV 100 mg single injection | 1 | Improvement in lung function; no need for hospitalization | 5 |
Bullard 1996 [30] | ED/pulmonology ward | Clinical and pulmonary function | 66.0 ± 10.9 | 60/113 | 53/113 | Hydrocortisone IV 100 mg/4 h ± 4 days or until discharge, then prednisolone PO 40 mg/day ± 4 days | 8 | Improvement in FEV1 at 6 h; no relapse or ED visit | 4 |
Thompson 1996 [31] | Ambulatory | Clinical | 67.8 ± 8.6 | 13/27 | 14/27 | Prednisone PO 60 mg/day ± 3 days followed by 40 mg/day ± 3 days, then 20 mg/day ± 3 days | 9 | Improvement in FEV1 at days 1, 3, and 10; improved blood gases and clinical symptoms | 5 |
Wood-Baker 1997 [32] | Pulmonology ward | Clinical | 72 ± 6.3 | 12/38 | 13/38 | (1) Prednisolone PO 2.5 mg/kg/day ± 3 days, then placebo ± 11 days | 3 | Improvement in lung function, 6-min walk test, hospitalization duration, improvement in clinical symptoms | 5 |
13/38 | (2) Prednisolone PO 0.6 mg/kg/day ± 7 days, then 0.3 mg/kg/day ± 7 days | 14 | FEV1 at day 1 and at 6 weeks, hospitalization duration, clinical improvement | ||||||
Davies 1999 [33] | Pulmonology ward | Clinical and pulmonary function. Exacerbation without acidosis | 67.3 ± 8.4 | 29/56 | 27/56 | Prednisone PO 30 mg/day ± 14 days | 14 | Elapsed time until treatment failure, improvement in FEV1, hospitalization duration | 5 |
Niewoehner 1999 [23] | Pulmonology ward | Clinical and pulmonary function | 67.7 ± 9.3 | 80/271 | 111/271 | (1) Methylprednisolone IV 125 mg/6 h ± 72 h followed by prednisone PO 60 mg/day with slow tapering for 54 days | 57 | Improvement in FEV1 and blood gases at day 3, clinical improvement, hospitalization duration | 5 |
80/271 | (2) Methylprednisolone IV 125 mg/6 h ± 72 h followed by prednisone PO 60 mg/day with slow tapering for 12 days | 15 | Lack of relapse or rehospitalization, improvement in FEV1, clinical improvement and improvement in life quality at day 10 | ||||||
Maltais 2002 [34] | Pulmonology ward | Clinical and pulmonary function | 70.4 ± 8.3 | 62/128 | 66/128 | Prednisone PO 30 mg/12 h ± 3 days, then 40 mg/day ± 7 days | 10 | Improvement in lung function, blood gases, and reduction in hospitalization duration | 4 |
Aaron 2003 [35] | Ambulatory | Clinical | 69.4 ± 10.8 | 74/147 | 73/147 | Prednisone PO 40 mg/day ± 10 days | 10 | I: no relapse or readmission, II: improvement in FEV1, clinical status, and quality of life at day 10 | 5 |
Chen 2008 [36] | Pulmonology ward | Clinical | 71.6 ± 7.3 | 44/130 | 43/130 | (1) Prednisone PO 30 mg/day ± 7 days | 7 | Improvement in FEV1, blood gases, hospitalization duration | 5 |
43/130 | (2) Prednisone PO 30 mg/day ± 10 days, then 15 mg/day ± 4 days | 14 | |||||||
Alia 2011 [37] | ICU | Clinical | 68.4 ± 10.2 | 43/83 | 40/83 | Methylprednisolone IV 0.5 mg/kg/6 h ± 3 days, then 0.5/kg/12 h ± 3 days followed by 0.5 mg/kg/day ± 4 days | 10 | Mechanical ventilation duration, ICU stay, and intubation rate | 5 |
Abroug 2014 [38] | ICU | Clinical | 69.0 ± 6 | 111/217 | 106/217 | Prednisone 1 mg/kg/day ± 10 days maximum or until discharge | 10 | Non-invasive ventilation success, ICU mortality in intubated patients | 3 |