Comparative Efficacies of Inhaled Corticosteroids and Systemic Corticosteroids in Treatment of Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review and Meta-Analysis

Background: Corticosteroids play an important role in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations, and a global initiative has suggested the use of inhaled corticosteroids (ICSs) as an alternative to systemic corticosteroids (SCs). Here, we report results of a meta-analysis performed to systematically compare the efficacies of ICSs and SCs in the treatment of COPD exacerbations. Methods: PubMed, EMBASE, and the Cochrane databases were searched for relevant human clinical trials describing the use of ICSs compared with SCs in the treatment of COPD exacerbations. We compared the results of FEV1%pred and blood gas analyses that had been calculated. Weighted mean differences and fixed effects models were applied by using Revman 5.2. Results: Five original studies satisfied our inclusion criteria, and no significant heterogeneity was shown. Three studies evaluated the increase of FEV1%pred after treatment for 7 days. There were three and four studies, respectively, that evaluated the increase of SaO(2) and PaO2, and three reported the decrease of PaCO2 at 24 hours control, 2-4 days control, and 7-10 days control. All the results showed that both ICSs and SCs were effective in the treatment of COPD exacerbations. Conclusion: ICSs were not inferior to SCs when used in the treatment of COPD exacerbations.