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SOCRATES 4 (synopsis of Cochrane reviews applicable to emergency services)
  1. P Gilligan1,
  2. M Shepherd1,
  3. G Lumsden1,
  4. H Law1,
  5. J Brenchley1,
  6. G Kitching1,
  7. A Taylor1,
  8. A Khan1,
  9. J Jones1,
  10. D Hegarty2
  1. 1Specialist Registrars in Emergency Medicine, The Yorkshire Rotation, UK
  2. 2General Practitioner, Leeds, UK
  1. Correspondence to:
 Dr P Gilligan
 1 Far Moss, Alwoodley, Leeds LS17 7NU, UK;

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In this the fourth article of the SOCRATES series we present the second half of the reviews from the Cochrane Database of Systematic Reviews relating to respiratory medicine that the working party felt were of particular relevance to emergency medicine practitioners. The methods of our review and the rationale for forming the SOCRATES working party are as have previously been published.


The treatment of acute exacerbations of COPD entails the reversal of bronchospasm, treatment of infection, and reduction of airway inflammation. The role of corticosteroids is evaluated in this review.


Seven randomised controlled trials comparing corticosteroids with placebo were included in this review. All other treatment options were standardised. The outcome measures reported varied considerably between the papers. The most commonly reported outcome, the FEV1 between 6 and 72 hours after treatment, showed no statistically significant difference between the glucocorticoid and placebo treatment. Treatment with glucocorticoid did show a significant benefit in relation to treatment failure and quality of life, but these outcome measures were not reported systematically by the papers.


The current evidence suggests that a short course …

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  • Funding: none.

  • Conflicts of interest: none declared.