Chest
Original ResearchCOPDInhaled Corticosteroids vs Placebo for Preventing COPD Exacerbations: A Systematic Review and Metaregression of Randomized Controlled Trials
Section snippets
Search Strategy and Selection Criteria
To identify the studies for inclusion in this review, all the authors independently searched the computer databases PubMed, Cochrane Central Database of Controlled trials, and EmBASE for relevant studies published from 1988 to 2008 using free text terms: inhaled corticosteroids, ICS, chronic obstructive pulmonary disease, and COPD, in various combinations, and limiting the search to English literature. Bibliographies of all selected articles and review articles that included information on the
Results
Our initial database search retrieved 1,095 citations (Fig 1). Of these, 177 studies were excluded as they did not involve COPD. Finally, 11 studies (8,164 study participants; 4,241 ICS, 3,923 placebo) that met our inclusion criteria were included in the final analysis.27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 All the studies were prospective, double-blind, randomized, placebo-controlled trials. The Jadad score was greater than three for all the studies, indicating high quality of the
Discussion
The results of this systematic review suggest that there is a modest relative risk reduction in COPD exacerbations with the use of ICS. In the sensitivity analysis, the beneficial effect was noted only in patients with FEV1 values less than 50%. There was presence of significant statistical heterogeneity with no evidence of publication bias. A metaregression analysis also failed to demonstrate a linear relationship between FEV1 values and decline in COPD exacerbations with the use of ICS.
The
Acknowledgments
Author contributions: Dr Agarwal: contributed to literature search, data analysis, and drafting of the manuscript.
Dr Aggarwal: contributed to literature search, data analysis, and drafting of the manuscript.
Dr Gupta: contributed to literature search and drafting of the manuscript.
Dr Jindal: contributed to literature search and drafting of the manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any
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