Dobler CC, et al. Ann Intern Med. 2020 Mar 17;172(6):413-422.
Questions & Methods: Systematic review of 68 English language RCTs of outpatient/non ICU inpatients with COPDE comparing pharmacologic therapy with placebo/ “usual care” to evaluate efficacy and AE
Findings: Antibiotic use associated with increased exacerbation resolution, OR 2.03 95% CI; systemic corticosteroids associated with less treatment failure OR 0.01 95%CI but higher adverse events
Limitations: English only, multiple unclear or high risk of bias, 65% reported adverse events, may not be generalizable to severe exacerbation or worse baseline function
Interpretation: With moderate to severe COPDE, consider initiation of antibiotics and systemic steroids, which is in line with GOLD recommendations