routes of steroid administration for copd exacerbation€¦ · systemic corticosteroid for copd...

SỬ DỤNG STEROIDS TRONG

ĐỢT CẤP COPD

Tại Sao vagrave Như Thế Nagraveo

Nguyễn Như Vinh ndash ĐHYD Tp Hồ Chiacute Minh

Nội dung

Đợt cấp lagrave gigrave

1 Tại sao cần SCS

2 Khi nagraveo cần

3 Liều như thế nagraveo

4 Thời gian dugraveng bao lacircu

5 Đường dugraveng

6 Taacutec dụng phụ ra sao

7 ICS coacute vai trograve khocircng

Kết luận

1 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016 httpwwwgoldcopdorg Last accessed July 2016

2 Marks A US Pharmacist 200934(7)HS-11-HS-15

bull Một tigravenh trạng nặng hơn của caacutec triệu chứng hocirc hấp1

bull Nặng hơn sự thay đổi hằng ngagravey

bull Cần phải thay đổi điều trị

bull Dựa vagraveo tam chứng1

bull Khoacute thở

bull Ho

bull Thay đổi đagravem

bull Giảm thiểu hậu quả của đợt cấp hiện tại vagrave ngăn chặn đợt cấp kế tiếp1

bull Giảm tần số vagrave độ nặng của đợt cấp coacute thể giảm tử vong liecircn quan đến COPD2

Định nghĩa

Chẩn đoaacuten

Điều trị (mục tiecircu)

Đợt cấp

Sinh bệnh học

Wedzicha JA amp Seemungal TA Lancet 2007370786ndash96

OrsquoDonnell DE et al COPD Research and Practice 201514

Phacircn tầng điều trị

12 Hosp Physician 2009389ndash16

Nội dung









Kết luận

COPD has pulmonary and systemic

components

Breathlessness

Bronchitis coughing sputum production

Emphysema hyperinflation wheezing

Skeletal muscle wasting amp

Cachexia

Comorbidities

(eg diabetes cardiovascular

disease osteoporosis)

Inhaled substances +

Genetic susceptibility

Airway

inflammation

Structural

changes

Mucociliary

dysfunction

copy 2017 Global Initiative for Chronic Obstructive Lung Disease

Tại sao sử dụng Corticoid trong đợt cấp


Tigravenh trạng viecircm xảy ra mạnh mẽ trong đợt cấp của

BPTNMT

Tigravenh trạng viecircm gia tăng ở bệnh nhacircn BPTNMT so với người huacutet thuốc laacute khocircng bị BPTNMT hay khocircng huacutet thuốc laacute Một khi đatilde higravenh thagravenh quaacute trigravenh viecircm sẽ tiếp diễn dugrave ngưng huacutet thuốc laacute vagrave viecircm xảy ra nhiều hơn khi bệnh nhacircn coacute đợt cấp do vi trugraveng hay virus

Cơ chế viecircm theo hướng tăng BCAT thường xảy ra khi bệnh nhacircn mắc BPTNMT vagraveo đợt cấp Caacutec nghiecircn cứu về sinh thiết niecircm mạc đường hocirc hấp cho thấy BCAT ở niecircm mạc phế quản tăng 30 lần trong đợt cấp


Caacutec nghiecircn cứu cho thấy sử dụng corticosteroid

toagraven thacircn trong đợt cấp COPD ruacutet ngắn thời gian

hồi phục vagrave cải thiện chức năng hocirc hấp (FEV1)

Corticosteroid toagraven thacircn cograven giuacutep cải thiện

Độ batildeo hogravea oxy

Nguy cơ taacutei phaacutet sớm

Thất bại điều trị

Thời gian nằm viện


Management of Exacerbations

Objective Strategy

Acute

Relieve dyspnea SABA +- short acting anticholinergic

Reduce airway

inflammationSystemic corticosteroids

Improve lung function Systemic corticosteroids

Eradicate infections Antibiotics

Maintenance Reduce risk of new

exacerbation

Smoking cessation

Pharmacotherapy bullSalmeterol +- fluticasone

bullFormoterol +- budesonide

bullTiotropium

ImmunizationsbullInfluenza

bullPneumonia

Pulmonary rehab

Self-management supportAnzueto A Am J Med Sci 2010 Jul 9

Cochrane Database of Systematic Reviews 2014 Issue 9 Art No

CD001288 Outcomes Relative effect

(95CI)

No of participants

(studies)

Quality of the

evidence

Treatment failure Need to intensify therapy ED or hospital admission

Follow-up3-30days

OR 048

(035-067)

917 (9studies) oplusoplusoplusoplushigh

Relapse Treatment for AE of COPD or hospital re-admission

Follow-up1-4months

OR 077

(051-117)

596 (5studies) oplusoplusoplusmoderate

Improvement in lung function-early effect FEV1(L) as absolute or change

Follow-up3days

014L higher

(009-020)


Decreased breathlessness-early effect Borg scale or VAS

Follow-up3days

035 SD higher

(005-064)


Adverse drug effect Follow-up2-26weeks

OR233

(159-343)


Hyperglycaemia OR279

(186-419)


Patient or population acute exacerbations COPD Settings outpatient

inpatient and people in ICU Intervention systemic corticosteroid

Comparison placebo

Systemic corticosteroids in acute exacerbation of COPD a meta-

analysis of controlled studies with emphasis on ICU patients

Annals of Intensive Care 2014 432

Primary endpoint treatment success

OR = 172

Do Systemic Corticosteroids Improve Outcomes in Chronic

Obstructive Pulmonary Disease Exacerbations

Annals of Emergency Medicine Volume 67 no 2 February 2016

Nội dung









Kết luận

When should acute exacerbations of COPD be treated

with systemic corticosteroids and antibiotics in primary

care a systematic review of current COPD guidelines

NPJ Prim Care Respir Med 2015 25 15002

Nội dung








Kết luận

Liều dugraveng

Pulm Pharmacol Ther 2014 Apr27(2)179-83 doi 101016jpupt201303004 Epub 2013 Mar 18

Comparison of two systemic steroid regimens for the treatment of COPD exacerbations

RATIONALE

Systemic steroids shorten recovery time improve lung function and hypoxemia in COPD exacerbations Although several studies have

shown that both parenteral and oral steroids are effective and GOLD guideline recommends use of oral steroids at a dose of 30-40 mgday

very little data exists as to whether any route of admininstration (parenteral vs oral) or any dose is more effective andor safer

METHODS

This was a randomized parallel-group study aiming to compare the effectiveness and safety of orally administered lower dose of steroids

with parenteral administration of higher doses Thus a total of 40 patients were included one group (Group 1 n = 20) received

methylprednisolone (MP) as recommended by the GOLD guideline (PO 32 mgday for seven days) and the other (Group 2 n = 20) was

given IV MP at 1 mgkgday for four days and 05 mgkgday for three days

RESULTS

The two groups were similar with regards to age (690 plusmn 105 vs 671 plusmn 84 years) duration of COPD (118 plusmn 83 vs 97 plusmn 77 years) FEV1 (413 plusmn 173

vs 340 plusmn 120) PaO2 levels (555 plusmn 99 vs 591 plusmn 110 mmHg) and dyspnea scores (94 plusmn 11 vs 100 plusmn 10) Worsening hypercapnic respiratory

failure developed in two patients from Group 1 on days 1 and 2 these were intubated and thus excluded from the study At day 7 both groups showed

significant improvements in FEV1 levels (508 plusmn 194 and 438 plusmn 214 respectively) (Table 2) PaO2 levels (665 plusmn 125 and 653 plusmn 106 mmHg

respectively) (Table 3) and dyspnea scores (35 plusmn 28 and 42 plusmn 28) (Fig 1) The length of hospital stay was similar for the two groups (110 plusmn 39 vs

127 plusmn 64) Regarding adverse events four patients in Group 1 vs 11 patients in group 2 developed hyperglycemia Besides three patients in group 2

had worsening of previously controlled hypertension All events were treated and controlled with administration of proper medications All patients

were followed up for three months Eight patients in group 1 and 15 patients in group 2 had unplanned visits to their physicians or to the emergency

rooms for recurring exacerbations Four patients in group 1 and five patients in group 2 were readmitted to hospital for recurrence (p = NS) During the

follow-up two patients from group 1 died

CONCLUSION

These data show that oral administration of MP at a dose 32 mgday for seven days significantly improves lung function symptom scores

and oxygenation in patients admitted to the hospital for COPD exacerbation and is as effective as and possibly safer than parenteral

admininistration of higher doses

Liều dugraveng

Liều dugraveng

Clin Respir J 2013 Oct7(4)305-18 doi 101111crj12008 Epub 2012 Nov 28

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

Cheng T1 Gong Y Guo Y Cheng Q Zhou M Shi G Wan H

Abstract

BACKGROUND

Systemic corticosteroids (SCS) have been shown to improve the outcome of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) However the optimal dose remains controversial

OBJECTIVES

We performed a meta-analysis to evaluate whether high-dose SCS is better

METHODS

We searched PubMed EMBASE CPCI-S and CENTRAL databases and references of reviews or meta-analyses to identify randomized controlled trials using SCS in AECOPD We performed a routine meta-analysis to evaluate the effects of SCS on treatment failure rate and forced expiratory volume in 1 s (FEV1) improvement compared with placebo in AECOPD Subgroup analysis was performed by dividing the studies into a high-dose group [initial dose ge80 mg prednisone equivalent (PE)day] and a low-dose group (initial dose 30-80 mg PEday) in all patients and in only inpatients Meta-regression was performed using initial dose as an independent factor We classified the suspected adverse effects into several groups and combined them separately

RESULTS

Our search yielded 12 studies involving 1172 patients SCS use was associated with a significant reduction in the treatment failure rate [risk ratio 058 95 confidence interval (CI) 046-073] and improvement in FEV1 (011 L 95 CI 008-014 L) The high-dose regimen did not show superiority to the low-dose regimen No obvious correlation was found between the SCS effect and the initial dose SCS led to an obvious increase in hyperglycemia risk However the high-dose group did not show obviously higher risk of adverse effects

CONCLUSION

SCS can reduce treatment failure rate and improve lung function in AECOPD The low-dose regimen (initial dose 30-80 mgday PE) is proper for treating AECOPD

Liều dugraveng

Ngoại truacute

GOLD amp Uptodate 40 mg prednisone uống x 5 ngagravey NICE 30 mg prednisone uống x 7-14 ngagravey

Nội truacute Chưa rotilde liều tối ưu

GOLD 40 mg prednisone uống x 5 ngagravey NICE 30 mg prednisone uống x 7-14 ngagravey

Uptodate 30-60 mg prednisone (1 lầnngagravey) 60-125 methylprednisone (2-4 lầnngagravey)

CorticosteroidLiều tương

đương

Hoạt tiacutenh khaacuteng viecircm

tương đối

Thời gian hoạt động

(giờ)

Taacutec dụng ngắn

Hydrocortisone 20 1 8-12

Cortisone acetate 25 08 8-12

Taacutec dụng tức thigrave

Prednisone 5 4 12-36

Prednisolone 5 4 12-36

Methylprednisolone 4 5 12-36

Triamcinolone 4 5 12-36

Taacutec dụng dagravei

Dexamethasone 075 30 36-72

Betamethasone 06 30 36-72

Liều tương đương của caacutec thuốc corticosteroid

GOLD 2018 ndash Uptodate 2018 - NICE 2010

Nội dung









Kết luận

J Fam Pract 2014 January63(1)29-3032

Thời gian dugraveng thuốc

JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023

Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary

disease the REDUCE randomized clinical trialIMPORTANCE

International guidelines advocate a 7- to 14-day course of systemic glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease (COPD)

However the optimal dose and duration are unknown

OBJECTIVE

To investigate whether a short-term (5 days) systemic glucocorticoid treatment in patients with COPD exacerbation is noninferior to conventional (14 days) treatment in

clinical outcome and whether it decreases the exposure to steroids DESIGN SETTING AND PATIENTS REDUCE (Reduction in the Use of Corticosteroids in

Exacerbated COPD) a randomized noninferiority multicenter trial in 5 Swiss teaching hospitals enrolling 314 patients presenting to the emergency department with acute

COPD exacerbation past or present smokers (ge20 pack-years) without a history of asthma from March 2006 through February 2011

INTERVENTIONS

Treatment with 40 mg of prednisone daily for either 5 or 14 days in a placebo-controlled double-blind fashion The predefined noninferiority criterion was an absolute

increase in exacerbations of at most 15 translating to a critical hazard ratio of 1515 for a reference event rate of 50

MAIN OUTCOME AND MEASURE Time to next exacerbation within 180 days

RESULTS

Of 314 randomized patients 289 (92) of whom were admitted to the hospital 311 were included in the intention-to-treat analysis and 296 in the per-protocol analysis

Hazard ratios for the short-term vs conventional treatment group were 095 (90 CI 070 to 129 P = 006 for noninferiority) in the intention-to-treat analysis and 093

(90 CI 068 to 126 P = 005 for noninferiority) in the per-protocol analysis meeting our noninferiority criterion In the short-term group 56 patients (359) reached

the primary end point 57 (368) in the conventional group Estimates of reexacerbation rates within 180 days were 372 (95 CI 295 to 449) in the short-term

384 (95 CI 306 to 463) in the conventional with a difference of -12 (95 CI -122 to 98) between the short-term and the conventional Among patients

with a reexacerbation the median time to event was 435 days (interquartile range [IQR] 13 to 118) in the short-term and 29 days (IQR 16 to 85) in the conventional

There was no difference between groups in time to death the combined end point of exacerbation death or both and recovery of lung function In the conventional group

mean cumulative prednisone dose was significantly higher (793 mg [95 CI 710 to 876 mg] vs 379 mg [95 CI 311 to 446 mg] P lt 001) but treatment-associated

adverse reactions including hyperglycemia and hypertension did not occur more frequently

CONCLUSIONS AND RELEVANCE

In patients presenting to the emergency department with acute exacerbations of COPD 5-day treatment with systemic

glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up but significantly

reduced glucocorticoid exposure These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD

From Short-term vs Conventional Glucocorticoid Therapy in Acute Exacerbations of Chronic Obstructive

Pulmonary Disease The REDUCE Randomized Clinical Trial

JAMA 2013309(21)2223-2231 doi101001jama20135023

Different durations of corticosteroid therapy for exacerbations of

chronic obstructive pulmonary disease (le7 days vs gt7 days)

OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure

Need for additional treatment

Follow-up 10 to 14 days

OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse

New acute exacerbation or COPD-related

admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate

Adverse drug effect - hyperglycaemia


OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate

Adverse drug effects Gastrointestinal tract bleeding symptomatic gastrointestinal

reflux symptoms of congestive heart failure or ischaemic

heart disease sleep disturbance fractures depression


OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝

Moderate Cochrane Database of Systematic Reviews 2018 Issue 3 Art No CD006897

With regards to duration of treatment a meta-analysis by Walters et al (Walters 2014b)

concluded that a shorter course of corticosteroids (around 5 days) is unlikely to lead to

worse outcomes compared with a longer course In 2013 Leuppi et al (Leuppi 2013)

reported on the largest randomised controlled trial in this area The authors found that a five

day course of corticosteroids (one 40mg dose of intravenous methylprednisolone followed by

four days of prednisolone 40mg) was non-inferior to treatment for 14 days (one IV dose plus 13

days of 40 mg prednisolone) regarding subsequent exacerbations and mortality over six

months of follow-up

In light of the evidence above it would appear that a 5 day course of oral prednisolone of

30mg to 50mg is adequate In patients who have been on oral corticosteroids for longer than

14 days tapering may be necessary Patients on long-term oral corticosteroid therapy (gt 75

mg prednisolone daily for more than 6 months) are at risk of developing osteoporosis

Prevention and treatment of corticosteroid-induced osteoporosis should be considered

Management of Exacerbations - Summary


Nội dung









Kết luận

Oral vs IV Steroids

de Jong et al (2007)4

5 days of 60 mg prednisolone daily either IV (n=107) or po (n=103)

Evaluated treatment failure death ICU admission readmission to ICU due to COPD or intensification of therapy within 90 days of treatment

Oral (563) non-inferior to IV (617)

Overall treatment failure higher than 2 week regimen in Niewoehner trial (38)1

First three days of Niewoehner trial featured steroid doses 26 times higher5

No data reported on adverse events

Ceviker Sayiner (2013)6

7 days of 32 mg methylprednisolone po daily (n=20)

4 days 1 mgkgday methylprednisolone IV then 3 days of 05 mgkgday (n=20)

Both groups showed improvement in FEV1 (491 oral vs 400 IV)

Less incidence of hyperglycemia in oral (222 vs 55)

Did not compare equipotent steroid doses

Intravenous corticosteroid compared with oral

corticosteroid for acute exacerbations of COPD

Cochrane Database of Systematic Reviews 2014 Issue 9 Art No CD001288

Đường dugraveng

GOLD ERSATS Uống (nếu đường tiecircu hoacutea

khocircng coacute vấn đề)

Mặc dugrave 90 BS Mỹ thiacutech dugraveng đường TM

OCS được hấp thụ nhanh với nồng độ huyết thanh

đạt đỉnh sau 1h sinh khả dụng đạt gần như hoagraven

toagraven vagrave coacute hiệu quả IV trong điều trị hầu hết caacutec

đợt cấp COPD

Hiệu quả điều trị tương đương

IV thời gian nằm viện lacircu hơn chi phiacute cao hơn

Nội dung









Kết luận

Do Corticosteroids Provide Benefit to Patients

With Community-Acquired Pneumonia

Annals of Emergency Medicine 2016 Volume 67 Issue 5 640 - 642

Systematic Review Snapshot

Nội dung









Kết luận

ICS vs SCS

J Aerosol Med Pulm Drug Deliv 2017 Oct30(5)289-298 doi 101089jamp20161353 Epub 2017 Mar 16

Comparative Efficacies of Inhaled Corticosteroids and Systemic Corticosteroids in Treatment of Chronic Obstructive Pulmonary Disease Exacerbations A Systematic Review and Meta-Analysis

BACKGROUND

Corticosteroids play an important role in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations and a global initiative has suggested the use of inhaled corticosteroids (ICSs) as an alternative to systemic corticosteroids (SCs) Here we report results of a meta-analysis performed to systematically compare the efficacies of ICSs and SCs in the treatment of COPD exacerbations

METHODS

PubMed EMBASE and the Cochrane databases were searched for relevant human clinical trials describing the use of ICSs compared with SCs in the treatment of COPD exacerbations We compared the results of FEV1pred and blood gas analyses that had been calculated Weighted mean differences and fixed effects models were applied by using Revman 52

RESULTS

Five original studies satisfied our inclusion criteria and no significant heterogeneity was shown Three studies evaluated the increase of FEV1pred after treatment for 7 days There were three and four studies respectively that evaluated the increase of SaO2 and PaO2 and three reported the decrease of PaCO2 at 24 hours control 2-4 days control and 7-10 days control All the results showed that both ICSs and SCs were effective in the treatment of COPD exacerbations

CONCLUSION

ICSs were not inferior to SCs when used in the treatment of COPD exacerbations

Kết luận

Corticoid đường toagraven thacircn lagrave thuốc khaacuteng viecircmhiệu quả cho nhiều bệnh nhacircn vagraveo đợt cấp củaBPTNMT

Liều điều trị ngoại truacute lagrave 30-40 mg ngagravey

Sử dụng đường uống được ưu tiecircn hơn tĩnh mạch vigravehiệu quả tương đương nhưng dễ sử dụng vagrave kinh tếhơn

Thời gian sử dụng 5-7 ngagravey được nhiều khuyến caacuteovigrave sử dụng dagravei ngagravey hơn chưa coacute bằng chứng hiệuquả hơn

Nội dung









Kết luận







bull Khoacute thở

bull Ho




Định nghĩa

Chẩn đoaacuten


Đợt cấp

Sinh bệnh học





Nội dung









Kết luận


components

Breathlessness




Cachexia

Comorbidities





Airway

inflammation

Structural

changes

Mucociliary

dysfunction





BPTNMT














Objective Strategy

Acute


Reduce airway





exacerbation

Smoking cessation



bullTiotropium


bullPneumonia

Pulmonary rehab




(95CI)

No of participants

(studies)

Quality of the

evidence


Follow-up3-30days

OR 048

(035-067)



Follow-up1-4months

OR 077

(051-117)



Follow-up3days

014L higher

(009-020)



Follow-up3days

035 SD higher

(005-064)



OR233

(159-343)



(186-419)




Comparison placebo





OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận











bull Khoacute thở

bull Ho




Định nghĩa

Chẩn đoaacuten


Đợt cấp

Sinh bệnh học





Nội dung









Kết luận


components

Breathlessness




Cachexia

Comorbidities





Airway

inflammation

Structural

changes

Mucociliary

dysfunction





BPTNMT














Objective Strategy

Acute


Reduce airway





exacerbation

Smoking cessation



bullTiotropium


bullPneumonia

Pulmonary rehab




(95CI)

No of participants

(studies)

Quality of the

evidence


Follow-up3-30days

OR 048

(035-067)



Follow-up1-4months

OR 077

(051-117)



Follow-up3days

014L higher

(009-020)



Follow-up3days

035 SD higher

(005-064)



OR233

(159-343)



(186-419)




Comparison placebo





OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Sinh bệnh học





Nội dung









Kết luận


components

Breathlessness




Cachexia

Comorbidities





Airway

inflammation

Structural

changes

Mucociliary

dysfunction





BPTNMT














Objective Strategy

Acute


Reduce airway





exacerbation

Smoking cessation



bullTiotropium


bullPneumonia

Pulmonary rehab




(95CI)

No of participants

(studies)

Quality of the

evidence


Follow-up3-30days

OR 048

(035-067)



Follow-up1-4months

OR 077

(051-117)



Follow-up3days

014L higher

(009-020)



Follow-up3days

035 SD higher

(005-064)



OR233

(159-343)



(186-419)




Comparison placebo





OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận







Nội dung









Kết luận


components

Breathlessness




Cachexia

Comorbidities





Airway

inflammation

Structural

changes

Mucociliary

dysfunction





BPTNMT














Objective Strategy

Acute


Reduce airway





exacerbation

Smoking cessation



bullTiotropium


bullPneumonia

Pulmonary rehab




(95CI)

No of participants

(studies)

Quality of the

evidence


Follow-up3-30days

OR 048

(035-067)



Follow-up1-4months

OR 077

(051-117)



Follow-up3days

014L higher

(009-020)



Follow-up3days

035 SD higher

(005-064)



OR233

(159-343)



(186-419)




Comparison placebo





OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận






components

Breathlessness




Cachexia

Comorbidities





Airway

inflammation

Structural

changes

Mucociliary

dysfunction





BPTNMT














Objective Strategy

Acute


Reduce airway





exacerbation

Smoking cessation



bullTiotropium


bullPneumonia

Pulmonary rehab




(95CI)

No of participants

(studies)

Quality of the

evidence


Follow-up3-30days

OR 048

(035-067)



Follow-up1-4months

OR 077

(051-117)



Follow-up3days

014L higher

(009-020)



Follow-up3days

035 SD higher

(005-064)



OR233

(159-343)



(186-419)




Comparison placebo





OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận







BPTNMT














Objective Strategy

Acute


Reduce airway





exacerbation

Smoking cessation



bullTiotropium


bullPneumonia

Pulmonary rehab




(95CI)

No of participants

(studies)

Quality of the

evidence


Follow-up3-30days

OR 048

(035-067)



Follow-up1-4months

OR 077

(051-117)



Follow-up3days

014L higher

(009-020)



Follow-up3days

035 SD higher

(005-064)



OR233

(159-343)



(186-419)




Comparison placebo





OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận

















Objective Strategy

Acute


Reduce airway





exacerbation

Smoking cessation



bullTiotropium


bullPneumonia

Pulmonary rehab




(95CI)

No of participants

(studies)

Quality of the

evidence


Follow-up3-30days

OR 048

(035-067)



Follow-up1-4months

OR 077

(051-117)



Follow-up3days

014L higher

(009-020)



Follow-up3days

035 SD higher

(005-064)



OR233

(159-343)



(186-419)




Comparison placebo





OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận







(95CI)

No of participants

(studies)

Quality of the

evidence


Follow-up3-30days

OR 048

(035-067)



Follow-up1-4months

OR 077

(051-117)



Follow-up3days

014L higher

(009-020)



Follow-up3days

035 SD higher

(005-064)



OR233

(159-343)



(186-419)




Comparison placebo





OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận









OR = 172




Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận








Nội dung









Kết luận





Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận









Nội dung








Kết luận

Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Liều dugraveng



RATIONALE




METHODS





RESULTS











CONCLUSION




Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Liều dugraveng

Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Liều dugraveng




Abstract

BACKGROUND


OBJECTIVES


METHODS


RESULTS


CONCLUSION


Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Liều dugraveng

Ngoại truacute






đương


tương đối


(giờ)














Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Nội dung









Kết luận



JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận







JAMA 2013 Jun 5309(21)2223-31 doi 101001jama20135023





OBJECTIVE





INTERVENTIONS




RESULTS
















JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận







JAMA 2013309(21)2223-2231 doi101001jama20135023



OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận







OutcomesRelative

effect

(95 CI)

Number of

participant

s

(studies)

Quality of

the

evidence

(GRADE)

Treatment failure



OR 072

(036 to 146)

457

(4 studies)

oplusoplusoplus⊝

Moderate

Relapse


admission


OR 104

(07 to 156)

478

(4 studies)

oplusoplusoplus⊝

Moderate



OR 099

(064 to 153)

345

(2 studies)

oplusoplusoplus⊝

Moderate





OR 088

(046 to 17)

503

(5 studies)

oplusoplus⊝⊝

Low ab

Mortality


OR 091

(04 to 206)

336

(2 studies)

oplusoplusoplus⊝









months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận












months of follow-up








Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận







Nội dung









Kết luận

Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Oral vs IV Steroids

















Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận








Đường dugraveng







đợt cấp COPD



Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Nội dung









Kết luận





Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận









Nội dung









Kết luận

ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





ICS vs SCS



BACKGROUND


METHODS


RESULTS


CONCLUSION


Kết luận





Kết luận





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