Therapy

Why?

• Steroids help reduce length of hospital stay (on average by a day) ^a and improve respiratory function (increasing FEV1 on average by 120 l/min at 72 hours (95% CI: 50 to 190), but not thereafter) ^a , 
• Steroids reduce treatment failure, but do not clearly reduce deaths. ^a
• However steroids commonly cause adverse-effects ^a , particularly diabetes. ^a

Steroids reduce treatment failure but cause adverse effects

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNH (95% CI)
acute exacerbation of COPD a	systemic steroids	placebo	treatment failure at days	29%	0.50 (0.32 to 0.79)	8 (6 to 22)
			adverse effects at days	25%	2.70 (1.72 to 4.23)	-5 (-9 to -2)

Steroids cause hyperglycaemia 

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNH (95% CI)
acute exacerbation of COPD a	steroids for 2 or 8 weeks	placebo	hyperglycaemia at weeks	4%	-316% (-1066% to -49%)	9 (6 to 21)