A Cochrane review [Abstract] 1 included 24 studies with a total of 1 083 subjects (80% male). More than half of the studies were published prior to 1989. All subjects had chronic airflow limitation, and most subjects had a long history of smoking. In all but one of the studies, the intervention group received prednisolone. Treatment lasted three weeks or less in 19 studies, high dose oral steroid (equivalent to prednisolone 30-40 mg daily) was used in 21 studies and subjects had moderate or severe COPD in 15 studies.
There was a significant difference in FEV1 after two weeks treatment, WMD 53.30 ml; 95% confidence interval 22.21 to 84.39 favouring oral steroid use compared to placebo when 14 studies with available data (n=396) were combined, with no significant heterogeneity. There was a significant increase in odds for individual patient FEV1 response greater than 20% from baseline with high dose oral steroid treatment compared to placebo, OR 2.71; 95% CI 1.84 to 4.01 (9 studies). It would be necessary to treat 7 patients (95% CI 5 to 12) with oral corticosteroids to achieve one extra case of increasing FEV1 by more than 20%, with a placebo group risk of 0.13. All differences in health-related quality of life were less than the minimum clinically important difference.
Primary/Secondary Keywords