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A meta-analysis published in Internal Medicine shows that antibiotics and systemic glucocorticoids are associated with fewer treatment failures in adults with COPD exacerbations compared to placebo or no therapeutic intervention.

In order to conduct a systematic review and meta-analysis, Claudia C. Dobler, MD, Bond University, Australia, and others evaluated 68 randomized controlled trials, including 10,758 adult patients with acute exacerbations of COPD who were treated in hospital or outpatient. The study compared pharmacological interventions with placebo, routine care or other pharmacological interventions.

Benefits of antibiotics and systemic glucocorticoids

In a comparative study of 7-10 days of systemic antibiotics and placebo or conventional care for inpatient or outpatient patients, at the end of treatment, antibiotics are related to the remission of the acute exacerbation of the disease, but have nothing to do with the severity of the exacerbation and the treatment environment ( OR = 2.03; 95% CI, 1.47- -2.8; moderate quality of evidence). After the end of therapeutic intervention, in the study of outpatients with mild acute exacerbations, systemic antibiotic therapy can reduce the treatment failure rate (OR = 0.54; 95% CI, 0.34-0.86; moderate evidence strength). Inpatients and outpatients with mild to moderate or moderate to severe exacerbations, antibiotics can also reduce breathing difficulties, coughing and other symptoms.

Similarly, for inpatients and outpatients, systemic glucocorticoids are compared with placebo or conventional care. After 9-56 days of treatment, systemic glucocorticoids are less likely to fail (OR = 0.01; 95% CI, 0- 0.13; the quality of the evidence is low), regardless of the treatment environment or the degree of acute exacerbation. At the end of 7-9 days of treatment, patients with mild to severe exacerbations in the outpatient clinic and hospitalized had their dyspnea relieved. However, systemic glucocorticoids are associated with an increase in the number of total and endocrine-related adverse events.

Researchers believe that based on their findings, doctors and colleagues should be assured that antibiotics and systemic glucocorticoids should be used in any acute exacerbation of COPD (even if it is mild). In the future, they may be able to better determine which patients will benefit the most from these treatments and which patients may not benefit (based on biomarkers, including C-reactive protein or procalcitonin, blood eosinophils).

Need more evidence

According to the investigators, there is a lack of decisive data on the preference of antibiotics or glucocorticoid therapy, and evidence of the use of other medications, including aminophylline, magnesium sulfate, anti-inflammatory drugs, inhaled corticosteroids, and short-acting bronchodilators.

The researcher said she would discourage doctors from using unproven treatments, such as aminophylline and magnesium sulfate. Researchers believe that although there are many studies on COPD, many drugs for treating acute exacerbations of COPD have insufficient evidence. For example, in clinical practice, we routinely use short-acting bronchodilators to relieve dyspnea during acute exacerbations of COPD. These include short-acting muscarinic receptor antagonists (ipratropium bromide) and short-acting beta receptor agonists (salbutamol).

In addition to higher-quality research, reliable research on drug treatments, the researchers also pointed out that other types of interventions may also be worth studying.

“A growing body of evidence suggests that certain non-pharmacological therapies, especially those starting to exercise early in the exacerbation phase, may improve the moderate to severe exacerbations of COPD patients in hospital. The American Thoracic Society/European Respiratory Conference in 2017 The issued guidelines include conditional recommendations (very low quality of evidence) during the hospitalization of acute exacerbations of COPD, do not start pulmonary rehabilitation, but some new evidence has emerged since then that we need a lot of high-quality evidence of early exercise during the acute exacerbation of COPD to Verify the effectiveness of early exercise for acute exacerbation of COPD.