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Short-term vs Conventional Glucocorticoid Therapy in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: the REDUCE randomized clinical trial

Methodology Score: 4/5                
Usefulness Score: 3.5/5

Leuppi JD, Schuetz P, Bingisser R, Bodmer M, Briel M, Drescher T, et al.
JAMA. 2013 Jun 5;309(21):2223-31


This multicentre, Swiss-based RCT adds to the literature that suggests a short course (5days) of corticosteroids is as effective as a longer course (14 days) for the inpatient COPD exacerbation population. JC attendees noted that almost all patients were treated as inpatients, so we cannot explicitly translate this research into outpatient management. However, it may be reasonable to consider a shorter duration of steroids in certain populations, knowing that the inpatient population did not demonstrate any additional harm and was non-inferior to standard therapy. 
By: Dr. Omer Yusuf
(Presented October 2013)

Epi lesson: Hazard Ratios
Hazard ratios are distinct from relative risk ratios. A relative risk ratio is the expression of the number of events in a treatment group vs. control group over the duration of a trial. Hazard ratios represent the risk of an event in the treatment group vs. control for a moment in time, often relative to a point in a survival curve analysis.
By: Dr. Lisa Calder

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