PMID- 32092762
OWN - NLM
STAT- MEDLINE
DCOM- 20200903
LR  - 20200903
IS  - 1539-3704 (Electronic)
IS  - 0003-4819 (Linking)
VI  - 172
IP  - 6
DP  - 2020 Mar 17
TI  - Pharmacologic Therapies in Patients With Exacerbation of Chronic Obstructive 
      Pulmonary Disease: A Systematic Review With Meta-analysis.
PG  - 413-422
LID - 10.7326/M19-3007 [doi]
AB  - BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by 
      frequent exacerbations. PURPOSE: To evaluate the comparative effectiveness and 
      adverse events (AEs) of pharmacologic interventions for adults with exacerbation 
      of COPD. DATA SOURCES: English-language searches of several bibliographic sources 
      from database inception to 2 January 2019. STUDY SELECTION: 68 randomized 
      controlled trials that enrolled adults with exacerbation of COPD treated in out- 
      or inpatient settings other than intensive care and compared pharmacologic 
      therapies with placebo, "usual care," or other pharmacologic interventions. DATA 
      EXTRACTION: Two reviewers independently extracted data and rated study quality 
      and strength of evidence (SOE). DATA SYNTHESIS: Compared with placebo or 
      management without antibiotics, antibiotics given for 3 to 14 days were 
      associated with increased exacerbation resolution at the end of the intervention 
      (odds ratio [OR], 2.03 [95% CI, 1.47 to 2.80]; moderate SOE) and less treatment 
      failure at the end of the intervention (OR, 0.54 [CI, 0.34 to 0.86]; moderate 
      SOE), independent of severity of exacerbations in out- and inpatients. Compared 
      with placebo in out- and inpatients, systemic corticosteroids given for 9 to 56 
      days were associated with less treatment failure at the end of the intervention 
      (OR, 0.01 [CI, 0.00 to 0.13]; low SOE) but also with a higher number of total and 
      endocrine-related AEs. Compared with placebo or usual care in inpatients, other 
      pharmacologic interventions (aminophyllines, magnesium sulfate, anti-inflammatory 
      agents, inhaled corticosteroids, and short-acting bronchodilators) had 
      insufficient evidence, showing either no or inconclusive effects (with the 
      exception of the mucolytic erdosteine) or improvement only in lung function. 
      LIMITATION: Scant evidence for many interventions; several studies had unclear or 
      high risk of bias and inadequate reporting of AEs. CONCLUSION: Antibiotics and 
      systemic corticosteroids reduce treatment failure in adults with mild to severe 
      exacerbation of COPD. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and 
      Quality. (PROSPERO: CRD42018111609).
FAU - Dobler, Claudia C
AU  - Dobler CC
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, and Institute 
      for Evidence-Based Healthcare, Bond University and Gold Coast University 
      Hospital, Gold Coast, Queensland, Australia (C.C.D.).
FAU - Morrow, Allison S
AU  - Morrow AS
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Beuschel, Bradley
AU  - Beuschel B
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Farah, Magdoleen H
AU  - Farah MH
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Majzoub, Abdul M
AU  - Majzoub AM
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Wilson, Michael E
AU  - Wilson ME
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Hasan, Bashar
AU  - Hasan B
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Seisa, Mohamed O
AU  - Seisa MO
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Daraz, Lubna
AU  - Daraz L
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Prokop, Larry J
AU  - Prokop LJ
AD  - Library Public Services, Mayo Clinic, Rochester, Minnesota (L.J.P.).
FAU - Murad, M Hassan
AU  - Murad MH
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
FAU - Wang, Zhen
AU  - Wang Z
AD  - Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the 
      Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota (A.S.M., B.B., 
      M.H.F., A.M.M., M.E.W., B.H., M.O.S., L.D., M.H.M., Z.W.).
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20200225
PL  - United States
TA  - Ann Intern Med
JT  - Annals of internal medicine
JID - 0372351
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Anti-Bacterial Agents/therapeutic use
MH  - Disease Progression
MH  - Humans
MH  - Pulmonary Disease, Chronic Obstructive/*drug therapy
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Failure
EDAT- 2020/02/25 06:00
MHDA- 2020/09/04 06:00
CRDT- 2020/02/25 06:00
PHST- 2020/02/25 06:00 [pubmed]
PHST- 2020/09/04 06:00 [medline]
PHST- 2020/02/25 06:00 [entrez]
AID - 2761822 [pii]
AID - 10.7326/M19-3007 [doi]
PST - ppublish
SO  - Ann Intern Med. 2020 Mar 17;172(6):413-422. doi: 10.7326/M19-3007. Epub 2020 Feb 
      25.