Withdrawal of Inhaled Corticosteroids in COPD Patients: Rationale and Algorithms

Overview

Journal Int J Chron Obstruct Pulmon Dis

Publisher Dove Medical Press

Specialty Pulmonary Medicine

Date 2019 Jul 30

PMID 31354256

Citations 14

Authors

Sergey Avdeev

Zaurbek Aisanov

Vladimir Arkhipov

Andrey Belevskiy

Igor Leshchenko

Svetlana Ovcharenko

Evgeny Shmelev

Marc Miravitlles

Affiliations

Soon will be listed here.

Abstract

Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

Citing Articles

Withdrawal of Inhaled Corticosteroids from Patients with COPD; Effect on Exacerbation Frequency and Lung Function: A Systematic Review.

Georgiou A, Ramesh R, Schofield P, White P, Harries T Int J Chron Obstruct Pulmon Dis. 2024; 19:1403-1419.

PMID: 38919905 PMC: 11198025. DOI: 10.2147/COPD.S436525.

The Impact of Inhaled Corticosteroids on the Prognosis of Chronic Obstructive Pulmonary Disease.

Park J, Hong Y, Rhee C, Choi H, Kim K, Yoo K Int J Chron Obstruct Pulmon Dis. 2023; 18:733-743.

PMID: 37159577 PMC: 10163892. DOI: 10.2147/COPD.S388367.

Investigating the rationale for COPD maintenance therapy prescription across Europe, findings from a multi-country study.

Kocks J, Ferreira A, Bakke P, van Schayck O, Ekroos H, Tzanakis N NPJ Prim Care Respir Med. 2023; 33(1):18.

PMID: 37137900 PMC: 10154184. DOI: 10.1038/s41533-023-00334-x.

LABA/LAMA as First-Line Therapy for COPD: A Summary of the Evidence and Guideline Recommendations.

Miravitlles M, Kawayama T, Dreher M J Clin Med. 2022; 11(22).

PMID: 36431099 PMC: 9692772. DOI: 10.3390/jcm11226623.

Risk of Tuberculosis Caused by Fluticasone Propionate versus Budesonide in Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Study.

Yu I, Park S, Hong S, Chang M, Lee S, Yong S J Pers Med. 2022; 12(7).

PMID: 35887686 PMC: 9321025. DOI: 10.3390/jpm12071189.

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