1. Example Conference EBM format
Noon Conference
Example Conference
EBM format
Set B1 – Title Slide

2. Case 65 year old white male Presents to ED via EMS with chief c/o SOB
Symptoms worsening over last 4 days
Productive cough
Wheezing
Using albuterol nebs 6-8 times per day with limited relief
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3. No fevers, chill, or night sweats Never had SOB like this in the past
No chest pain
No fevers, chill, or night sweats
Never had SOB like this in the past
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4. PMH/PSH COPD Gold Stage III HTN Hyperlipidemia DM diet controlled
FEV1 45% predicted
HTN
Hyperlipidemia
DM diet controlled
Appendectomy in 1978
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5. Medications Advair 250/50 one inhalation BID
Spireva 18 mcg one inhalation QD
ProAir HFA 2 puffs every 4 hrs as needed
Albuterol Nebs every 4 hrs as needed
HCTZ 25mg/day
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6. Social 55 pack year tobacco history; quit in 1998
Previous heavy Etoh use; sober since 1998
No IVDA
No occupational or TB exposures
No recent travel
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7. FMH
CAD
Father had MI at age 72 DM
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8. ROS
Negative except for HPI
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9. Physical Exam T 100.5 P 105 R 22 BP 105/68 SpO2 90% HEENT wnl
CV tachy but regular
Lungs wheezing throughout
Abdomen benign
Ext no edema
Neuro intact
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10. Imaging
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11. Labs
WBC 12.1
Hb 15.6
Chemistries wnl
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12. EKG
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13. Diagnosis
Acute exacerbation COPD
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14. Clinical Question Question Population/problem: Intervention:
65 year old male with an acute exacerbation of COPD 
Intervention:
Systemic corticosteroids + bronchodilators
Comparison:
Bronchodilators alone
Outcome:
Treatment Failure
Question
In patients with acute exacerbations of COPD, do systemic steroids improve rate of treatment success when compared to bronchodilators alone?
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15. The Search Type of question Database Search terms Therapy Pubmed
Systemic corticosteroids and acute exacerbation COPD
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16. Citation
BS, Gan WQ, Sin DD. Contemporary management of acute exacerbations of COPD: a systematic review and meta-analysis. Chest Mar;133(3): Review.
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17. Summary of the Evidence
Metaanalysis of contemporary management of AECOPD
10 studies involving 959 patients reviewed
6 of the ten studies (742 patients) specifically looking at treatment failures
Failure defined as clinical deterioration, study withdrawal, relapse
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18. Summary of the Evidence
Overall treatment failure reduced by 46%
RR 0.54 (95% CI )
NNT is approximately 6
Hyperglycemia RR 5.88
Will be seen in 1 in every 10 pt treated with steroids
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19. Summary of the Evidence
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20. Summary of the Evidence
Doses in studies range from 60 mg qd to 100 mg q4h from 8-15 days
Ideal dose not identified
Extended length therapy (> 2wks) does improve benefit
All studies in which risk of treatment failure was reported (6 of 10) there was a decrease in failures
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21. Do these apply to my patient?
Yes this study applies to this patient
Similar characteristics as patients enrolled in included studies
Has an identified COPD exacerbation
Concern for hyperglycemia needs to be considered in this patient
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22. Bottom Line
Patients who have an acute exacerbation of COPD and who are treated with steroids have a lower risk of treatment failures.
Hyperglycemia occurs frequently in patients with AECOPD who receive steroids.
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23. Closing Slide