Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

Abstract

Inhaled corticosteroids (ICSs) are a mainstay of COPD treatment for patients with a history of exacerbations. Initial studies evaluating their use as monotherapy failed to show an effect on rate of pulmonary function decline in COPD, despite improvements in symptoms and reductions in exacerbations. Subsequently, ICS use in combination with long-acting β2-agonists (LABAs) was shown to provide improved reductions in exacerbations, lung function, and health status. ICS-LABA combination therapy is currently recommended for patients with a history of exacerbations despite treatment with long-acting bronchodilators alone. The presence of eosinophilic bronchial inflammation, detected by high blood eosinophil levels or a history of asthma or asthma–COPD overlap, may define a population of patients in whom ICSs may be of particular benefit. Prospective clinical studies to determine an appropriate threshold of eosinophil levels for predicting the beneficial effects of ICSs are needed. Further study is also required in COPD patients who continue to smoke to assess the impact of cell- and tissue-specific changes on ICS responsiveness. The safety profile of ICSs in COPD patients is confounded by comorbidities, age, and prior use of systemic corticosteroids. The risk of pneumonia in patients with COPD is increased, particularly with more advanced age and worse disease severity. ICS-containing therapy also has been shown to increase pneumonia risk; however, differences in study design and the definition of pneumonia events have led to substantial variability in risk estimates, and some data indicate that pneumonia risk may differ by the specific ICS used. In summary, treatment with ICSs has a role in dual and triple therapy for COPD to reduce exacerbations and improve symptoms. Careful assessment of COPD phenotypes related to risk factors, triggers, and comorbidities may assist in individualizing treatment while maximizing the benefit-to-risk ratio of ICS-containing COPD treatment.

LABAs and p38MAPK Inhibitors Reverse the Corticosteroid-Insensitivity of IL-8 in Airway Smooth Muscle Cells of COPD

“…There are several clinical trials and meta-analyses that suggest a superiority of LABA/ICS combinations to respective monotherapies regarding exacerbation rates, lung function decline, and health status in COPD [2]. Our data might explain this superiority by an increased anti-inflammatory efficacy of the ICS through the reversion of the corticosteroid resistance by LABAs.…”

“…COPD therapy is complicated by the partial resistance/insensitivity of the airway inflammation to inhaled corticosteroids (ICS) [1]. ICS use increases the risk of pneumonia in COPD [2]. Therefore, a careful assessment of ICS use in COPD is required, e.g., by identifying responder phenotypes.…”

Single-inhaler triple therapy in patients with chronic obstructive pulmonary disease: a systematic review

“…regimen and dose) and study design-related factors (e.g. patient characteristics and definitions used) [41]. In the present study, the pneumonia risk for single-inhaler triple therapy ranged from no reported increase to a significant increase.…”

Provider anticipation and experience of patient reaction when deprescribing guideline discordant inhaled corticosteroids

“…2. Evidence of higher risk of pneumonia and potential fragility fractures while on ICS [18][19][20]; and 3. The availability of safer, effective alternatives such as a combination inhaler for both long acting muscarinic antagonist (LAMA) and long acting beta agonist (LABA) [21].…”