Inhaled corticosteroids in COPD: the final verdict is…

Leung, Janice M.; Sin, Don D.

doi:10.1183/13993003.01940-2018

Cited by 18 publications

(10 citation statements)

References 16 publications

(24 reference statements)

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“…ICS are widely used in the treatment of patients with COPD [53,54]. The availability of combined LABDs and increasing recognition of the potential adverse effects of ICS treatment has led to a gradual re-evaluation of their role [1,55].…”

Section: Discussionmentioning

confidence: 99%

Withdrawal of inhaled corticosteroids in COPD: a European Respiratory Society guideline

et al. 2020

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Inhaled corticosteroids (ICS) combined with bronchodilators can reduce the frequency of exacerbations in some patients with chronic obstructive pulmonary disease (COPD). There is evidence, however, that ICS are frequently used in patients where their benefit has not been established. Therefore, there is a need for a personalised approach to the use of ICS in COPD and to consider withdrawal of ICS in patients without a clear indication. This document reports European Respiratory Society recommendations regarding ICS withdrawal in patients with COPD.Comprehensive evidence synthesis was performed to summarise all available evidence relevant to the question: should ICS be withdrawn in patients with COPD? The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence synthesis was discussed and recommendations formulated by a committee with expertise in COPD and guideline methodology.After considering the balance of desirable and undesirable consequences, quality of evidence, and feasibility and acceptability of interventions, the guideline panel made: 1) conditional recommendation for the withdrawal of ICS in patients with COPD without a history of frequent exacerbations, 2) strong recommendation not to withdraw ICS in patients with blood eosinophil counts ≥300 eosinophils·µL−1 and 3) strong recommendation to treat with one or two long-acting bronchodilators if ICS are withdrawn.A conditional recommendation indicates that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention.

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Section: Discussionmentioning

confidence: 99%

Withdrawal of inhaled corticosteroids in COPD: a European Respiratory Society guideline

et al. 2020

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“…If these data can be recapitulated in high‐quality randomized controlled trials, metformin may represent a novel therapeutic class of drugs to reduce morbidity and mortality of COPD patients. In the meantime, patients with COPD should be treated with bronchodilators and possibly inhaled corticosteroids, for those who are frequent exacerbators and have an elevated blood eosinophil count, defined as >300 cells/μL or have concomitant asthma …”

Section: Treatments Of Today As Well As Tomorrowmentioning

confidence: 99%

“…In the meantime, patients with COPD should be treated with bronchodilators and possibly inhaled corticosteroids, for those who are frequent exacerbators and have an elevated blood eosinophil count, defined as >300 cells/ μL or have concomitant asthma. 23 For those with resting hypoxaemia, supplemental (domiciliary) oxygen should be provided. However, this therapy is expensive.…”

Section: Treatments Of Today As Well As Tomorrowmentioning

confidence: 99%

Contemporary Concise Review 2019: Chronic obstructive pulmonary disease

Sin

2020

Respirology

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“…However, the person-based number needed to treat (NNT) per year of LAMA/LABA/ICS combination compared with LAMA/LABA combination was significantly lower in patients with ≥300 blood eosinophils·µL −1 than in those with <300 eosinophils·µL −1 . In fact, the NNT to prevent one ECOPD over 1 year was only 8 to 10 patients for those with blood eosinophil counts of at ≥300 cells·µL −1 but was about 47 for those with blood eosinophil counts <300 cells·µL −1 , a number that is likely to be unacceptable for most clinicians 32 . If pneumonia is considered as the outcome, the person-based number needed to harm (NNH) of LAMA/LABA/ICS combination therapy versus LAMA/LABA combination therapy was 195.34 (95% confidence interval (CI) 85.06–∞) but diminished to 33.89 (95% CI 30.69–37.84) when the only randomized controlled trial that included fluticasone furoate in the triple combination was analyzed.…”

Section: Adding An Inhaled Corticosteroidmentioning

confidence: 99%

Pharmacological treatment and current controversies in COPD

et al. 2019

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Bronchodilators, corticosteroids, and antibiotics are still key elements for treating chronic obstructive pulmonary disease in the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations and this is due in part to our current inability to discover new drugs capable of decisively influencing the course of the disease. However, in recent years, information has been produced that, if used correctly, can allow us to improve the use of the available therapies.

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Inhaled corticosteroids in COPD: the final verdict is…

Cited by 18 publications

References 16 publications

Withdrawal of inhaled corticosteroids in COPD: a European Respiratory Society guideline

Withdrawal of inhaled corticosteroids in COPD: a European Respiratory Society guideline

Contemporary Concise Review 2019: Chronic obstructive pulmonary disease

Pharmacological treatment and current controversies in COPD

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