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Objectives: To conduct a systematic review and meta-analysis regarding the efficacy and safety of inhaled corticosteroids for COPD exacerbationsin the emergency department. Methods: MEDLINE, Embase, the Cochrane Library, and the Cochrane Central Register of Controlled Trials were searched from December 2010 to June 2015 and the Cochrane Database of Systematic Reviews was searched up to February 2016. The primary objective was to review studies of the efficacy and safety of inhaled corticosteroids for COPD exacerbations in the emergency department; secondary objectives included assessing the role of bronchodilator therapy and a potential role of beta1-imulinic enzyme in COPD. Data from these meta-analyses were weighted. Results: The search results and studies included in the meta-analysis were available for 1,9791 subjects. The quality of reviews and meta-analyses were acceptable. When the results of randomised controlled trials were included they were included in 11 studies. The efficacy was significantly associated with inhaled corticosteroid in acute exacerbations and with increased time to resolution of acute exacerbations. There was a clear dose response function, indicating that there were few patients who developed COPD more than once or twice; however, more than a third of patients in the inhaled corticosteroid group and a significant proportion of patients in beta1-imulinic enzyme, which showed a decreased incidence of COPD, developed COPD more than once in the study. Studies were limited by small sample sizes with low mean differences and the use of a single, unblinded assessor. There were no trials that evaluated the role of beta1-imulinic enzyme or bronchodilator therapy in COPD. However, bronchodilator therapy is associated with reduced mortality in COPD. Conclusions: This systematic review and meta-analysis provide evidence for inhaled corticosteroid with little or no risk of harm. When included in the meta-analysis bronchodilator therapy is associated with more frequent resolution of acute exacerbations, and there is evidence to suggest an improved outcome in COPD. Back to top Article Information Correspondence: David Chai, MSc, Research Associate, Department of Emergency Medicine, Queen Mary, University of London, College Road, London WC1E 7AB, UK (daich@qmul.ac.uk). Accepted for Publication: November 30, 2016. Published Online: January 29, 2017. doi:10.1001/jamainternmed.2016.2136 Author Contributions: Dr Related Article:
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