Long-term impact of inhaled corticosteroid use in asthma and chronic obstructive pulmonary disease (COPD): Review of mechanisms that underlie risks

Singanayagam, Aran; Johnston, Sebastian L.

doi:10.1016/j.jaci.2019.12.907

Cited by 18 publications

(14 citation statements)

References 10 publications

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“…This is associated with increased viral replication, and excess mucin production [ 84 ]. The use of ICS in COPD patients may therefore increase susceptibility to virus infection, and/or worsen clinical outcomes through these mechanisms [ 87 ]. Secondary bacterial infection in such cases provide one possible explanation for the increased bacterial presence and pneumonia risk observed with ICS use in COPD patients [ 83 ].…”

Section: Ics Use In Copd: Implications For Covid-19mentioning

confidence: 99%

COVID-19 and COPD: a narrative review of the basic science and clinical outcomes

et al. 2020

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The 2019 coronavirus disease (COVID-19) pandemic is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Clinical outcomes, including mortality, are worse in males, older individuals and patients with comorbidities. COPD patients are included in shielding strategies due to their susceptibility to virus-induced exacerbations, compromised pulmonary function and high prevalence of associated comorbidities. Using evidence from basic science and cohort studies, this review addresses key questions concerning COVID-19 and COPD. First, are there mechanisms by which COPD patients are more susceptible to SARS-CoV-2 infection? Secondly, do inhaled corticosteroids offer protection against COVID-19? And, thirdly, what is the evidence regarding clinical outcomes from COVID-19 in COPD patients? This up-to-date review tackles some of the key issues which have significant impact on the long-term outlook for COPD patients in the context of COVID-19.

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Section: Ics Use In Copd: Implications For Covid-19mentioning

confidence: 99%

COVID-19 and COPD: a narrative review of the basic science and clinical outcomes

et al. 2020

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“…However, the risk of mortality not related to COVID-19 was also observed to be higher in patients with COPD taking ICS-containing therapy versus LABA/LAMA, with an adjusted hazard ratio of 1.23 (95% CI, 1.08-1.40). This in turn perhaps suggests that other factors such as local immunosuppression due to ICS in the presence of impaired mucociliary clearance and altered microbiome 3…”

Section: To the Editormentioning

confidence: 99%

Inhaled corticosteroids and angiotensin-converting enzyme-2 in COPD

Lipworth

Chan

Kuo

2021

Journal of Allergy and Clinical Immunology

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“…ICS use in patients with COPD is associated with adverse effects: altering the antiviral immune response [74], modifying the composition of the microbiome [75], increasing bacterial load [76], the risk of respiratory infections, pneumonia [77], and mycobacteria infection [78]. Accordingly, ICS could theoretically promote "de novo" respiratory infections and pneumonic episodes either by inducing the growth of bacteria within the existing lung microbiota or by contributing to the acquisition of new bacteria from the environment [79]. Additionally, around 50% of ICS-induced pneumonias in COPD occur following a viral illness [80].…”

Section: Inhaled Corticosteroids In Chronically Infected Copd Patientsmentioning

confidence: 99%

“…In this scenario, the impact of an ICS in patients with COPD and an already existing CBI must be carefully evaluated. This has led to a shifting paradigm, with increasing recognition that the potentially detrimental effects of ICS on anti-microbial immunity should be carefully weighed up against any potentially beneficial anti-inflammatory and clinical effects [ 79 ]. Consistently, current guidance documents advocate more selective ICS use in COPD than in asthma [ 67 , 72 ].…”

Section: Inhaled Corticosteroids In Chronically Infected Copd Patimentioning

confidence: 99%

Current Challenges in Chronic Bronchial Infection in Patients with Chronic Obstructive Pulmonary Disease

Lόpez-Campos

Miravitlles

Rosa

et al. 2020

JCM

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Currently, chronic obstructive pulmonary disease (COPD) patients and their physicians face a number of significant clinical challenges, one of which is the high degree of uncertainty related to chronic bronchial infection (CBI). By reviewing the current literature, several challenges can be identified, which should be considered as goals for research. One of these is to establish the bases for identifying the biological and clinical implications of the presence of potentially pathogenic microorganisms in the airways that should be more clearly elucidated according to the COPD phenotype. Another urgent area of research is the role of long-term preventive antibiotics. Clinical trials need to be carried out with inhaled antibiotic therapy to help clarify the profile of those antibiotics. The role of inhaled corticosteroids in patients with COPD and CBI needs to be studied to instruct the clinical management of these patients. Finally, it should be explored and confirmed whether a suitable antimicrobial treatment during exacerbations may contribute to breaking the vicious circle of CBI in COPD. The present review addresses the current state of the art in these areas to provide evidence which will enable us to progressively plan better healthcare for these patients.

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Long-term impact of inhaled corticosteroid use in asthma and chronic obstructive pulmonary disease (COPD): Review of mechanisms that underlie risks

Cited by 18 publications

References 10 publications

COVID-19 and COPD: a narrative review of the basic science and clinical outcomes

COVID-19 and COPD: a narrative review of the basic science and clinical outcomes

Inhaled corticosteroids and angiotensin-converting enzyme-2 in COPD

Current Challenges in Chronic Bronchial Infection in Patients with Chronic Obstructive Pulmonary Disease

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