Original Article

Systemic corticosteroid for COPD exacerbations, whether the higher dose is better? A meta-analysis of randomized controlled trials

  1. Ting Cheng1,
  2. Yi Gong2,
  3. Yi Guo1,
  4. QiJian Cheng1,*,
  5. Min Zhou1,
  6. GuoChao Shi1,
  7. HuanYing Wan1,*

Article first published online: 28 NOV 2012

DOI: 10.1111/crj.12008

Additional Information

How to Cite

Please cite this paper as: Cheng T, Gong Y, Guo Y, Cheng QJ, Zhou M, Shi GC, Wan HY. Systemic corticosteroid for COPD exacerbations, whether the higher dose is better? A meta-analysis of randomized controlled trials. Clin Respir J 2012; ●●: ●●–●●. DOI:10.1111/crj.12008.

Author Information

  1. 1

    Department of Pulmonary Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

  2. 2

    Department of Pulmonary Medicine, Huashan Hospital, Shanghai Fudan University, Shanghai, China

* Correspondence
HuanYing Wan, MD, Department of Pulmonary Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China.
Tel: 86-21-64370045-680828
Fax: +86 021 6431 4162
email: hy_wan2006@yahoo.com.cn; 13917425214@126.com
QiJian Cheng, MD, PhD, Department of Pulmonary Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China.
Tel: 86-15900784590
Fax: +86 021 6431 4162
email: chengqijian@yahoo.cn

  1. Authorship and contributorshipHuanYing Wan, QiJian Cheng and GuoChao Shi designed the study and revised this paper. Ting Cheng and Yi Gong searched the database, judged study eligibility, extracted data and drafted the main part of the article. Ting Cheng, Yi Gong and QiJian Cheng did the meta-analyses. Ting Cheng, Yi Guo and Min Zhou did the subgroup analyses and meta-regression. QiJian Cheng, Min Zhou and Yi Guo also drafted part of the article and revised this article. Ting Cheng and Yi Gong contributed equally to this work as co-first authors. HuanYing Wan and QiJian Cheng contributed equally to this work as co-corresponding authors. All authors have read and approve this version of the article.

  2. EthicsPermission to conduct the study was obtained by the ethics committee at Ruijin Hospital (2009 临伦审第23号), where the study was conducted, and the need for written informed consent was waived.

  3. Conflict of interestThe authors have stated explicitly that there are no conflicts of interest in connection with this article.

Publication History

  1. Article first published online: 28 NOV 2012
  2. Accepted manuscript online: 16 OCT 2012 09:39AM EST
  3. Manuscript Accepted: 10 OCT 2012
  4. Manuscript Revised: 17 SEP 2012
  5. Manuscript Received: 26 JUN 2012

Funded by

  • 11th National Five-year Development Plan of China. Grant Number: 2008BAI52B00

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Figure S1. Data extraction form.

Figure S2. Funnel plot comparing lnRR vs the SE of lnRR (A) and FEV1 improvement (▵FEV1) related to the SCS use vs the SE of ▵FEV1 (B) to evaluate the publication bias. Open circles represent trials included in the meta-analysis. The line in the center indicates the summary log RR and the summary ▵FEV1. The other lines represent the 95% CIs. There is no evidence of publication bias. RR, risk ratio; SE, standard error.

Figure S3. Subgroup analysis of the effect of SCS on treatment failure rate in AECOPD patient by different definition of treatment failure. D group: Death, intubation, RR = 0.60. R group: Relapse, hospitalization, readmission, intensification of drug therapy, withdrawal. RR = 0.58. M group: Mixed. RR = 0.59. N group: Not mentioned. RR = 0.52.

Figure S4. The effect of systemic corticosteroids on FEV1% predicted. The FEV1 improvement was 5.65%.

Figure S5. Sketch map of the data in some paper. Adapted from Deeks, JJ, Higgins, JPT, Altman, DG, 9.4.5.2 Meta-analysis of change scores. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 (updated September 2008). The Cochrane Collaboration, 2008. Available from: http://www.cochrane-handbook.org

Table S1. The definition of COPD exacerbation.

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