Table 1.

Patients characteristics and steroid regimen in the studies included in the meta-analysis

Study and publication year	Setting	Exacerbation criteria	Mean age (SD)	Patient number		Intervention	Duration (days)	Endpoint and success criteria	Jadad score
				Systemic corticosteroids ( n / N )	Controls ( n / N )
Albert 1980 [29]	Pulmonology ward	Clinical and pulmonary function	61.5 ± 9.5	22/44	22/44	Methylprednisolone IV 0.5 mg/kg/6 h × 72 h	3	Improvement in lung function	5
Emerman 1989 [28]	ED	Clinical and pulmonary function	64.0 ± 7.8	52/96	44/96	Methylprednisolone IV 100 mg single injection	1	Improvement in lung function; no need for hospitalization	5
Bullard 1996 [30]	ED/pulmonology ward	Clinical and pulmonary function	66.0 ± 10.9	60/113	53/113	Hydrocortisone IV 100 mg/4 h × 4 days or until discharge, then prednisolone PO 40 mg/day × 4 days	8	Improvement in FEV1 at 6 h; no relapse or ED visit	4
Thompson 1996 [31]	Ambulatory	Clinical	67.8 ± 8.6	13/27	14/27	Prednisone PO 60 mg/day × 3 days followed by 40 mg/day × 3 days, then 20 mg/day × 3 days	9	Improvement in FEV1 at days 1, 3, and 10; improved blood gases and clinical symptoms	5
Wood-Baker 1997 [32]	Pulmonology ward	Clinical	72 ± 6.3	12/38	13/38	(1) Prednisolone PO 2.5 mg/kg/day × 3 days, then placebo × 11 days	3	Improvement in lung function, 6-min walk test, hospitalization duration, improvement in clinical symptoms	5
				13/38		(2) Prednisolone PO 0.6 mg/kg/day × 7 days, then 0.3 mg/kg/day × 7 days	14	FEV1 at day 1 and at 6 weeks, hospitalization duration, clinical improvement
Davies 1999 [33]	Pulmonology ward	Clinical and pulmonary function. Exacerbation without acidosis	67.3 ± 8.4	29/56	27/56	Prednisone PO 30 mg/day × 14 days	14	Elapsed time until treatment failure, improvement in FEV1, hospitalization duration	5
Niewoehner 1999 [23]	Pulmonology ward	Clinical and pulmonary function	67.7 ± 9.3	80/271	111/271	(1) Methylprednisolone IV 125 mg/6 h × 72 h followed by prednisone PO 60 mg/day with slow tapering for 54 days	57	Improvement in FEV1 and blood gases at day 3, clinical improvement, hospitalization duration	5
				80/271		(2) Methylprednisolone IV 125 mg/6 h × 72 h followed by prednisone PO 60 mg/day with slow tapering for 12 days	15	Lack of relapse or rehospitalization, improvement in FEV1, clinical improvement and improvement in life quality at day 10
Maltais 2002 [34]	Pulmonology ward	Clinical and pulmonary function	70.4 ± 8.3	62/128	66/128	Prednisone PO 30 mg/12 h × 3 days, then 40 mg/day × 7 days	10	Improvement in lung function, blood gases, and reduction in hospitalization duration	4
Aaron 2003 [35]	Ambulatory	Clinical	69.4 ± 10.8	74/147	73/147	Prednisone PO 40 mg/day × 10 days	10	I: no relapse or readmission, II: improvement in FEV1, clinical status, and quality of life at day 10	5
Chen 2008 [36]	Pulmonology ward	Clinical	71.6 ± 7.3	44/130	43/130	(1) Prednisone PO 30 mg/day × 7 days	7	Improvement in FEV1, blood gases, hospitalization duration	5
				43/130		(2) Prednisone PO 30 mg/day × 10 days, then 15 mg/day × 4 days	14
Alia 2011 [37]	ICU	Clinical	68.4 ± 10.2	43/83	40/83	Methylprednisolone IV 0.5 mg/kg/6 h × 3 days, then 0.5/kg/12 h × 3 days followed by 0.5 mg/kg/day × 4 days	10	Mechanical ventilation duration, ICU stay, and intubation rate	5
Abroug 2014 [38]	ICU	Clinical	69.0 ± 6	111/217	106/217	Prednisone 1 mg/kg/day × 10 days maximum or until discharge	10	Non-invasive ventilation success, ICU mortality in intubated patients	3

R, randomization; B, blindness; L, lost to follow-up; SD, standard deviation; n, patients in the study arm; N, total sample size.