adrenal cortex hormones

Calcium pyrophosphate deposition (CPPD) disease is caused by CPP crystal accumulation in musculoskeletal tissues, leading to inflammation
Symptomatic CPPD disease (formerly known as “pseudogout”) is more common in older than younger adults and typically affects joints with previous damage. Chondrocalcinosis visible on radiographs affects 10% of adults and 50% of those older than 80 years, but most people are asymptomatic and findings are noted incidentally.1

The most common presentation is acute inflammatory monoarthritis affecting the wrists or knees, which resolves within 4 weeks
Extra-articular structures can also be affected, leading to acute inflammatory tendinitis. Crowned dens syndrome comprises 5% of CPPD disease presentations and can mimic bacterial meningitis, manifesting with acute cervical neck pain, fever, and elevated inflammatory markers with CPPD at C1 to C2, seen on computed tomography. The chronic (> 3 mo) inflammatory phenotype presents with hand or wrist symmetric polyarthritis, or with recurrent flares, and can be misdiagnosed as seronegative rheumatoid arthritis. Calcium pyrophosphate deposition disease and osteoarthritis can co-exist — underlying CPPD disease should be considered in patients with osteoarthritis at atypical locations (e.g., metacarpophalangeal joints, wrists, ankles, shoulders, elbows).2

Diagnosis can be confirmed with CPP crystals identified from synovial fluid, or the presence of the crowned dens syndrome
Although used for research, the 2023 Classification Criteria have high sensitivity (99.2%) and specificity (92.5%), thereby providing a diagnostic framework.2 Supportive diagnostic features include acute knee or wrist inflammatory arthritis in an older adult, osteoarthritis at atypical areas, or CPPD on imaging.3

Patients younger than 60 years at diagnosis should be assessed for associated metabolic diseases
Investigations for secondary causes of CPPD disease include calcium (hypercalcemia), parathyroid hormone (hyperparathyroidism), ferritin, transferrin saturation (hemochromatosis), magnesium (hypomagnesemia), and alkaline phosphatase (hypophosphatasia).2

Corticosteroids, colchicine, and nonsteroidal antiinflammatory drugs can treat acute flares4
Inflammatory arthritis lasting more than 3 months or recurrent flares (> 2/yr) should prompt rheumatology referral for consideration of chronic suppressive colchicine, hydroxychloroquine, or methotrexate (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.250933/tab-related-content).5

Author/s:

Timothy S.H. Kwok, Gregory Choy

Treatment of Atopic Dermatitis

Megan George — Thu, 21 Aug 2025 15:59:01 +0000

Date Added:

August 21, 2025

Journal/Publication:

JAMA

Publication Date:

August 20, 2025

URL:

Treatment of Atopic Dermatitis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.11589

Keywords

dermatology

atopic dermaitis

A review of currently available treatment methods for patients with atopic dermatitis. James W. Mold, MD, MPH

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Author/s:

Aaron M. Drucker

Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE– and Institute of Medicine–based recommendations

Alex Haga — Sun, 11 Aug 2024 18:08:48 +0000

Date Added:

August 11, 2024

Journal/Publication:

Ann Allergy Asthma Immunol

Publication Date:

December 17, 2023

Issue:

Volume:

132

Pages:

274-312

URL:

Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE– and Institute of Medicine–based recommendations

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.anai.2023.11.009

Keywords

allergy

asthma

Atopic Dermatitis

PMID (1):

38108679

MeSH

adrenal cortex hormones

Asthma*

Dermatitis

Atopic* / drug therapy

Eczema*

A 2023 updated guideline for management of patients with atopic dermatitis. James W. Mold, MD, MPH

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Background: Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology.

Objective: To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD.

Methods: A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles.

Results: The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts.

Conclusion: These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).

Author/s:

AAAAI/ACAAI JTF Atopic Dermatitis Guideline Panel, Derek K Chu, Lynda Schneider, Rachel Netahe Asiniwasis, Mark Boguniewicz

Management of Latent Tuberculosis Infection

Aubrey Delammermore — Wed, 02 Aug 2023 05:00:00 +0000

Date Added:

February 8, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 7, 2023

Issue:

Volume:

329

Pages:

421-422

URL:

Management of Latent Tuberculosis Infection

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.24362

Keywords

prednisone

Tuberculin

Centers for Disease Control and Prevention, U.S.

tuberculosis

Infection

PMID (1):

36656598

MeSH

Immunosuppressive Agents

adrenal cortex hormones

Interferon-gamma Release Tests

Tumor Necrosis Factor Inhibitors

Latent Tuberculosis

A review of the current recommendations for identification and treatment of latent TB infections. James W. Mold, MD, MPH

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In theUS, approximately 13million people have latent tuberculosis infection (LTBI),definedaspeoplewhoareinfectedwithMycobacterium
tuberculosiswho do not have symptoms and do not transmit the disease.Without treatment, approximately 5% to 10% of immunocompetent personswithLTBI develop active TB disease in their lifetimes.1
In 2016, the US Preventive Services Task Force recommended
screening all at-risk adults older than 18 years for LTBI with a blood
test (interferon-gamma release assay) or a tuberculin skin test. Atrisk individuals include those from TB-endemic regions and those
who are immunocompromised or are starting an immunosuppressive medication, such as tumor necrosis factor antagonists or systemic corticosteroids at a dose of at least 15 mg of prednisone per
day, or take immunosuppressive drugsafter organ transplant.2Evaluation for LTBI should include a medical history, physical examination, and chest radiographic imaging to rule out active TB disease.
After confirmation that active TB is not present, LTBI treatment can
be initiated. This article reviews the 2020 Centers for Disease Control and Prevention and National Tuberculosis Controllers Association LTBI treatment recommendations.1

Author/s:

Kim, S., Thal, R., Szwarko, D.

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Aubrey Delammermore — Sat, 19 Nov 2022 06:00:00 +0000

Date Added:

November 19, 2022

Journal/Publication:

Circulation

Publisher:

American Heart Association

Publication Date:

November 3, 2022

URL:

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1161/CIR.0000000000001095

Keywords

AHA Scientific Statements

Advanced life support

PMID (1):

36325905

MeSH

Term Birth

Cardiopulmonary Resuscitation

Respiratory Distress Syndrome

Coronary Angiography

adrenal cortex hormones

An updated, comprehensive review and guideline for basic and advanced cardiopulmonary resuscitation of neonates, infants, children, and adults developed by an international consensus panel. James W. Mold, MD, MPH

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This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

Author/s:

Wyckoff, M. H., Greif, R., Morely, P. T., Ng, K., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Böttiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castrén, M., Chang, W., Charlton, N. P., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T. B., Dainty, K. N., Davis, P. G., Fernanda de Almeida, M., R. de Caen, A., Deakin, C. D., Djärv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Fogila, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M. D., Kim, H., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y. J., Lockey, A. S., Maconochie, I. K., Madar, R. J., Hansen, C. M., Masterson, S., Matsuyama, T., McKinlay, C. J. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y. G., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. F., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rüdiger, M., Sakamota, T., Sandroni, C., Sawyer, T. L., Schexnayder, S. M., Schmölzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van de Voorde, P., Wang, T., Weiner, G. M., Wyllie, J. P., Yang, C., Yeung, J., Nolan, J. P., Berg, K. M.

Therapy for Mild to Moderate Asthma

Aubrey Delammermore — Wed, 27 Jul 2022 05:00:00 +0000

Date Added:

July 27, 2022

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

July 21, 2022

Pages:

URL:

Therapy for Mild to Moderate Asthma

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.12258

Keywords

asthma

Mild to Moderate Asthma

therapy

recommendations

Asthma Therapy

PMID (1):

35862052

MeSH

asthma

adrenal cortex hormones

nebulizers and vaporizers

formoterol fumarate

-(2-(4-azidobenzamidino)ethyl)-5-hydroxyindole

Updated guidelines for management of mild to moderate asthma. James W. Mold, MD,MPH

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GUIDELINE TITLE Global Strategy for Asthma Management
and Prevention (GINA Strategy Report)
RELEASE DATE April 26, 2021
PRIOR VERSION April 3, 2020
DEVELOPER AND FUNDING SOURCE The Global Initiative for
Asthma (GINA)
TARGET POPULATION Patients aged 12 y with asthma
MAJOR RECOMMENDATIONS
• Short-acting β-agonist (SABA) monotherapy is no longer
recommended (level of evidence: A).
• There is no distinction between mild-intermittent
and mild-persistent asthma; inhaled corticosteroid
(ICS)–containing therapies are recommended for
both. ICS-formoterol is recommended as the preferred
reliever inhaler (level of evidence: A).
• For treatment of moderate asthma, GINA recommends
ICS-formoterol maintenance and reliever therapy in
the preferred track (level of evidence: A).

Author/s:

Gray, S. E., Cife, A. S., Press, V. G.

Interventional Treatments for Acute and Chronic Pain: Systematic Review

Bethie Seay — Mon, 13 Sep 2021 05:00:00 +0000

Date Added:

September 13, 2021

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.23970/AHRQEPCCER247

A review of the evidence regarding the use of vertebroplasty, kyphoplasty, and cool radiofrequency denervation for acute and chronic back pain.

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Objective. To evaluate the benefits and harms of selected interventional procedures for acute and chronic pain that are not currently covered by the Centers for Medicare & Medicaid Services (CMS) but are relevant for and have potential utility for use in the Medicare population, or that are covered by CMS but for which there is important uncertainty or controversy regarding use.

Data sources. Electronic databases (Ovid® MEDLINE®, PsycINFO®, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews) to April 12, 2021, reference lists, and submissions in response to a Federal Register notice.

Review methods. Using predefined criteria and dual review, we selected randomized controlled trials (RCTs) for 10 interventional procedures and conditions that evaluated pain, function, health status, quality of life, medication use, and harms. Random effects meta-analysis was conducted for vertebral compression fracture; otherwise, outcomes were synthesized qualitatively. Effects were classified as small, moderate, or large using previously defined criteria.

Results. Thirty-seven randomized trials (in 48 publications) were included. Vertebroplasty (13 trials) is probably more effective at reducing pain and improving function in older (>65 years of age) patients, but benefits are small (less than 1 point on a 10-point pain scale). Benefits appear smaller (but still present) in sham-controlled (5 trials) compared with usual care controlled trials (8 trials) and larger in trials of patients with more acute symptoms; however, testing for subgroup effects was limited by imprecision. Vertebroplasty is probably not associated with increased risk of incident vertebral fracture (10 trials). Kyphoplasty (2 trials) is probably more effective than usual care for pain and function in older patients with vertebral compression fracture at up to 1 month (moderate to large benefits) and may be more effective at >1 month to ≥1 year (small to moderate benefits) but has not been compared against sham therapy. Evidence on kyphoplasty and risk of incident fracture was conflicting. In younger (below age for Medicare eligibility) populations, cooled radiofrequency denervation for sacroiliac pain (2 trials) is probably more effective for pain and function versus sham at 1 and 3 months (moderate to large benefits). Cooled radiofrequency for presumed facet joint pain may be similarly effective versus conventional radiofrequency, and piriformis injection with corticosteroid for piriformis syndrome may be more effective than sham injection for pain. For the other interventional procedures and conditions addressed, evidence was too limited to determine benefits and harms.

Conclusions. Vertebroplasty is probably effective at reducing pain and improving function in older patients with vertebral compression fractures; benefits are small but similar to other therapies recommended for pain. Evidence was too limited to separate effects of control type and symptom acuity on effectiveness of vertebroplasty. Kyphoplasty has not been compared against sham but is probably more effective than usual care for vertebral compression fractures in older patients. In younger populations, cooled radiofrequency denervation is probably more effective than sham for sacroiliac pain. Research is needed to determine the benefits and harms of the other interventional procedures and conditions addressed in this review.

Author/s:

Chou, R., Fu, R., Dana, T., Pappas, M., Hart, E., Mauer, K. M.

Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 14, 2021

Journal/Publication:

Journal of the American Medical Association Network Open

Publication Date:

December 16, 2020

Issue:

Volume:

URL:

Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.1001/jamanetworkopen.2020.29581

Keywords

PMID (1):

33326025

MeSH

Bursitis

Physical Therapy Modalities

exercise therapy

Electric Stimulation Therapy

adrenal cortex hormones

This meta-analysis suggests that an intra-articular injection of a corticosteroid can benefit patients with frozen shoulder syndrome. James W. Mold, MD, MPH

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mportance: There are a myriad of available treatment options for patients with frozen shoulder, which can be overwhelming to the treating health care professional.

Objective: To assess and compare the effectiveness of available treatment options for frozen shoulder to guide musculoskeletal practitioners and inform guidelines.

Data sources: Medline, EMBASE, Scopus, and CINHAL were searched in February 2020.

Study selection: Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.

Data extraction and synthesis: Data were independently extracted by 2 individuals. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Random-effects models were used.

Main outcomes and measures: Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome. Results of pairwise meta-analyses were presented as mean differences (MDs) for pain and ER ROM and standardized mean differences (SMDs) for function. Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.

Results: From a total of 65 eligible studies with 4097 participants that were included in the systematic review, 34 studies with 2402 participants were included in pairwise meta-analyses and 39 studies with 2736 participants in network meta-analyses. Despite several statistically significant results in pairwise meta-analyses, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain (vs no treatment or placebo: MD, -1.0 visual analog scale [VAS] point; 95% CI, -1.5 to -0.5 VAS points; P < .001; vs physiotherapy: MD, -1.1 VAS points; 95% CI, -1.7 to -0.5 VAS points; P < .001) and function (vs no treatment or placebo: SMD, 0.6; 95% CI, 0.3 to 0.9; P < .001; vs physiotherapy: SMD 0.5; 95% CI, 0.2 to 0.7; P < .001). Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to IA corticosteroid may be associated with added benefits in the mid-term (eg, pain for IA coritocosteriod with home exercise vs no treatment or placebo: MD, -1.4 VAS points; 95% CI, -1.8 to -1.1 VAS points; P < .001).

Conclusions and relevance: The findings of this study suggest that the early use of IA corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.

Author/s:

Challoumas, Dimitris, Biddle, Mairiosa, McLean, Michael, Millar, Neal L.

Association Between Oral Corticosteroid Bursts and Severe Adverse Events: A Nationwide Population-Based Cohort Study

Brian Desmarais — Thu, 09 Jul 2020 19:43:59 +0000

Date Added:

July 9, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

July 7, 2020

URL:

Association Between Oral Corticosteroid Bursts and Severe Adverse Events: A Nationwide Population-Based Cohort Study

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.7326/M20-0432.

Keywords

oral corticosteroids

MeSH

Longitudinal Studies

Gastrointestinal Hemorrhage

Sepsis

adrenal cortex hormones

Short bursts of oral corticosteroids are associated with an approximately 2-fold increase in GI bleeding, sepsis, and CHF 5 – 30 days following treatment. While the overall rate in this longitudinal study was low (2.7%), it wasn’t clinically insignificant. James W. Mold, MD, MPH

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Abstract

Background: Long-term use of oral corticosteroids has known adverse effects, but the risk from brief oral steroid bursts (≤14 days) is largely unknown.

Objective: To examine the associations between steroid bursts and severe adverse events, specifically gastrointestinal (GI) bleeding, sepsis, and heart failure.

Design: Self-controlled case series.

Setting: Entire National Health Insurance Research Database of medical claims records in Taiwan.

Participants: Adults aged 20 to 64 years with continuous enrollment in the National Health Insurance program from 1 January 2013 to 31 December 2015.

Measurements: Incidence rates of severe adverse events in steroid burst users and non-steroid users, as well as incidence rate ratios (IRRs) for severe adverse events within 5 to 30 and 31 to 90 days after initiation of steroid therapy.

Results: Of 15 859 129 adult participants, 2 623 327 who received a single steroid burst were included. The most common indications were skin disorders and respiratory tract infections. The incidence rates per 1000 person-years in steroid bursts were 27.1 (95% CI, 26.7 to 27.5) for GI bleeding, 1.5 (CI, 1.4 to 1.6) for sepsis, and 1.3 (CI, 1.2 to 1.4) for heart failure. Rates of GI bleeding (IRR, 1.80 [CI, 1.75 to 1.84]), sepsis (IRR, 1.99 [CI, 1.70 to 2.32]), and heart failure (IRR, 2.37 [CI, 2.13 to 2.63]) significantly increased within 5 to 30 days after steroid therapy initiation and attenuated during the subsequent 31 to 90 days.

Limitation: Persons younger than 20 years or older than 64 years were not included.

Conclusion: Oral corticosteroid bursts are frequently prescribed in the general adult population in Taiwan. The highest rates of GI bleeding, sepsis, and heart failure occurred within the first month after initiation of steroid therapy.

Primary funding source: National Health Research Institutes, Ministry of Science and Technology of Taiwan, Chang Gung Medical Foundation, and Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Author/s:

Yao, T., Huang, Y., Chang, S., Tsai, S., Wu, A.C., Tsai, H.

Global Initiative for Asthma report: How will new recommendations affect practice in Canada?

Brian Desmarais — Tue, 28 Apr 2020 16:16:14 +0000

Date Added:

April 28, 2020

Journal/Publication:

Canadian Medical Association Journal

Publisher:

Canadian Medical Association

Publication Date:

April 1, 2020

Issue:

Volume:

193

Pages:

E456- E458

URL:

Global Initiative for Asthma report: How will new recommendations affect practice in Canada?

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.191445

Keywords

asthma

asthma treatment

recommendations

The Global Initiative

MeSH

asthma

adrenal cortex hormones

formoterol fumarate

The Global Initiative on Asthma has updated its recommendations for management of mild intermittent asthma. James W. Mold, MD, MPH

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Not available.

Author/s:

Beauchesne, M., Lemiere, C.

Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD: A Systematic Review

John Bayhi — Fri, 18 Oct 2019 13:01:46 +0000

Date Added:

October 18, 2019

Journal/Publication:

AHRQ Website

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

October 11, 2019

URL:

Pharmacologic and Nonpharmacologic Therapies in Adult Patients With Exacerbation of COPD

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.23970/AHRQEPCCER221

Keywords

copd

chronic obstructive pulmonary disease

therapy

randomized control trial

systematic review

Key points are on page ii. Antibiotics and corticosteroids and some non-pharmacologic strategies are effective. We still don’t know the best corticosteroid dose or route. James W. Mold, MD, MPH

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Objectives. To synthesize existing knowledge about the effectiveness and harms of pharmacologic and nonpharmacologic treatments for exacerbations of chronic obstructive pulmonary disease (ECOPD).

Data sources. Embase®, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE® Daily, MEDLINE, Cochrane Central Registrar of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus from database inception to January 2, 2019.

Review methods. We included randomized controlled trials (RCTs) that evaluated pharmacologic intervention or nonpharmacologic interventions for ECOPD. The strength of evidence (SOE) was graded for critical final health outcomes.

Results. We included 98 RCTs (13,401 patients, mean treatment duration 9.9 days, mean followup 3.7 months). Final health outcomes, including mortality, resolution of exacerbation, hospital readmissions, repeat exacerbations, and need for intubation, were infrequently evaluated and often showed no statistically significant differences between groups. Antibiotic therapy increases the clinical cure rate and reduces the clinical failure rate regardless of the severity of ECOPD (moderate SOE). There is insufficient evidence to support a particular antibiotic regimen. Oral and intravenous corticosteroids improve dyspnea and reduce the clinical failure rate (low SOE). Despite the ubiquitous use of inhaled bronchodilators in ECOPD, we found only a small number of trials that assessed lung function tests, and not final health outcomes. The evidence is insufficient to support the effect of aminophyllines, magnesium sulfate, mucolytics, inhaled corticosteroids, inhaled antibiotics, 5-lipoxygenase inhibitor, and statins on final health outcomes. Titrated oxygen reduces mortality compared with high flow oxygen (low SOE). Low SOE suggested benefit from some nonpharmacologic interventions such as chest physiotherapy using vibration/percussion/massage or breathing technique (on dyspnea), resistance training (on dyspnea and quality of life), early pulmonary rehabilitation commenced before hospital discharge during the initial most acute phase of exacerbation rather than the convalescence period (on dyspnea) and whole body vibration training (on quality of life). Vitamin D supplementation may improve quality of life (low SOE).

Conclusions. Although chronic obstructive pulmonary disease is a common condition, the evidence base for most interventions in ECOPD remains limited. Systemic antibiotics and corticosteroids are associated with improved outcomes in mild and moderate to severe ECOPD. Titrated oxygen reduces mortality. Future research is required to assess the effectiveness of several emerging nonpharmacologic and dietary treatments.

Author/s:

Dobler, CC, Morrow, AS, Farah, MH, Beuschel, B, Majzoub, AM, Wilson, ME, Hasan, B, Seisa, MO, Daraz, L, Prokop, LJ, Murad, MH, Wang, Z

Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease

Jeffrey Wilson — Wed, 02 Jan 2019 14:50:14 +0000

Date Added:

January 2, 2019

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

Cochrane Library

Publication Date:

March 6, 2018

Pages:

CD006897

URL:

Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD006897.pub4

Keywords

copd

corticosteroids

PMID (1):

29553157

MeSH

pulmonary disease, chronic obstructive

adrenal cortex hormones

Corticosteroids should be continued for no more than 5 – 7 days when treating patients with severe COPD exacerbations. This is consistent with the updated 2018 GOLD guideline.

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BACKGROUND:

Current guidelines recommend that patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) should be treated with systemic corticosteroid for seven to 14 days. Intermittent systemic corticosteroid use is cumulatively associated with adverse effects such as osteoporosis, hyperglycaemia and muscle weakness. Shorter treatment could reduce adverse effects.

OBJECTIVES:

To compare the efficacy of short-duration (seven or fewer days) and conventional longer-duration (longer than seven days) systemic corticosteroid treatment of adults with acute exacerbations of COPD.

SEARCH METHODS:

Searches were carried out using the Cochrane Airways Group Specialised Register of Trials, MEDLINE and CENTRAL (Cochrane Central Register of Controlled Trials) and ongoing trials registers up to March 2017.

SELECTION CRITERIA:

Randomised controlled trials comparing different durations of systemic corticosteroid defined as short (i.e. seven or fewer days) or longer (i.e. longer than seven days). Other interventions-bronchodilators and antibiotics-were standardised. Studies with participants requiring assisted ventilation were excluded.

DATA COLLECTION AND ANALYSIS:

We used standard methodological procedures as expected by The Cochrane Collaboration.

MAIN RESULTS:

Eight studies with 582 participants met the inclusion criteria, of which five studies conducted in hospitals with 519 participants (range 28 to 296) contributed to the meta-analysis. Mean ages of study participants were 65 to 73 years, the proportion of male participants varied (58% to 84%) and COPD was classified as severe or very severe. Corticosteroid treatment was given at equivalent daily doses for three to seven days for short-duration treatment and for 10 to 15 days for longer-duration treatment. Five studies administered oral prednisolone (30 mg in four, tapered in one), and two studies provided intravenous corticosteroid treatment. Studies contributing to the meta-analysis were at low risk of selection, performance, detection and attrition bias. In four studies we did not find a difference in risk of treatment failure between short-duration and longer-duration systemic corticosteroid treatment (n = 457; odds ratio (OR) 0.72, 95% confidence interval (CI) 0.36 to 1.46)), which was equivalent to 22 fewer per 1000 for short-duration treatment (95% CI 51 fewer to 34 more). No difference in risk of relapse (a new event) was observed between short-duration and longer-duration systemic corticosteroid treatment (n = 457; OR 1.04, 95% CI 0.70 to 1.56), which was equivalent to nine fewer per 1000 for short-duration treatment (95% CI 68 fewer to 100 more). Time to the next COPD exacerbation did not differ in one large study that was powered to detect non-inferiority and compared five days versus 14 days of systemic corticosteroid treatment (n = 311; hazard ratio 0.95, 95% CI 0.66 to 1.37). In five studies no difference in the likelihood of an adverse event was found between short-duration and longer-duration systemic corticosteroid treatment (n = 503; OR 0.89, 95% CI 0.46 to 1.69, or nine fewer per 1000 (95% CI 44 fewer to 51 more)). Length of hospital stay (n = 421; mean difference (MD) -0.61 days, 95% CI -1.51 to 0.28) and lung function at the end of treatment (n = 185; MD FEV1 -0.04 L; 95% CI -0.19 to 0.10) did not differ between short-duration and longer-duration treatment.

AUTHORS' CONCLUSIONS:

Information from a new large study has increased our confidence that five days of oral corticosteroids is likely to be sufficient for treatment of adults with acute exacerbations of COPD, and this review suggests that the likelihood is low that shorter courses of systemic corticosteroids (of around five days) lead to worse outcomes than are seen with longer (10 to 14 days) courses. We graded most available evidence as moderate in quality because of imprecision; further research may have an important impact on our confidence in the estimates of effect or may change the estimates. The studies in this review did not include people with mild or moderate COPD; further studies comparing short-duration systemic corticosteroid versus conventional longer-duration systemic corticosteroid for treatment of adults with acute exacerbations of COPD are required.

Author/s:

Walters, Julia A.E., Tan, Daniel J., White, Clinton J., Wood-Baker, Richard

Different Durations of Corticosteroid therapy for Exacerbations of Chronic Obstructive Pulmonary Disease

Jeffrey Wilson — Wed, 22 Aug 2018 16:34:21 +0000

Date Added:

November 1, 2018

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

Cochrane Library

Publication Date:

March 19, 2018

Issue:

URL:

Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD006897.pub4

Keywords

corticosteroids

copd

chronic obstructive pulmonary disease

PMID (1):

29553157

MeSH

pulmonary disease, chronic obstructive

adrenal cortex hormones

5 days of systemic corticosteroids is sufficient for treatment of patients with acute COPD exacerbations.

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BACKGROUND:

OBJECTIVES:

To compare the efficacy of short-duration (seven or fewer days) and conventional longer-duration (longer than seven days) systemic corticosteroid treatment of adults with acute exacerbations of COPD.

SEARCH METHODS:

SELECTION CRITERIA:

DATA COLLECTION AND ANALYSIS:

We used standard methodological procedures as expected by The Cochrane Collaboration.

MAIN RESULTS:

AUTHORS' CONCLUSIONS:

Author/s:

Walters, Julia A.E., Wang, Wendy, Morley, Carla, Soltani, Amir, Wood-Baker, Richard