Withdrawal of inhaled corticosteroids can be safe in COPD patients at low risk of exacerbation: a real-life study on the appropriateness of treatment in moderate COPD patients (OPTIMO)

Rossi, Andrea; Guerriero, Massimo; Corrado, Antonio

doi:10.1186/1465-9921-15-77

Cited by 119 publications

(95 citation statements)

References 31 publications

(66 reference statements)

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“…All patients were also receiving an LABA and a long‐acting, muscarinic antagonist. The finding that withdrawal of ICS in COPD may not increase exacerbation rates has been replicated …”

Section: Discussionmentioning

confidence: 91%

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Inappropriate inhaled corticosteroid prescribing in chronic obstructive pulmonary disease patients

Harrison

Borg

Thompson

et al. 2017

Internal Medicine Journal

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The Australian National Chronic Obstructive Pulmonary Disease (COPD) guidelines recommend that inhaled corticosteroids (ICS) be reserved for patients with a post-bronchodilator forced expiratory volume in 1 s (FEV ) less than 50% predicted and those who experience ≥2 exacerbations in 12 months. In total, 707 COPD patients were identified from the lung function test database at our tertiary hospital; 52.4% of patients with a post-bronchodilator FEV ≥50% were prescribed an ICS. Significant discordance exists between guideline recommendations and inhaler prescription.

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“…All patients were also receiving an LABA and a long‐acting, muscarinic antagonist. The finding that withdrawal of ICS in COPD may not increase exacerbation rates has been replicated …”

Section: Discussionmentioning

confidence: 91%

“…The finding that withdrawal of ICS in COPD may not increase exacerbation rates has been replicated. 10,11 There is evidence that ICS may be harmful. Inhaled corticosteroids increase the risk of developing pneumonia in COPD.…”

Section: Brief Communicationsmentioning

confidence: 99%

Inappropriate inhaled corticosteroid prescribing in chronic obstructive pulmonary disease patients

Harrison

Borg

Thompson

et al. 2017

Internal Medicine Journal

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“…This requires further investigation. ICS back titration is now a focus of both asthma and COPD management following studies published in 2014 showing that ICS dose reduction in COPD was possible without an increase in exacerbations 83 84. Whether this is safe in asthma–COPD overlap remains to be determined.…”

Section: Future Researchmentioning

confidence: 99%

Asthma-COPD overlap 2015: now we are six

Gibson

McDonald

2015

Thorax

184

156

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BackgroundThe overlap between asthma and COPD is increasingly recognised. This review examines the new insights, treatment and remaining knowledge gaps for asthma–COPD overlap.MethodA systematic literature review of cluster analyses of asthma and COPD was performed. Articles from 2009 to the present dealing with prevalence, morbidity and treatment of asthma–COPD overlap were identified and reviewed.ResultsAsthma–COPD overlap was consistently recognised in studies using a variety of different study designs and sampling. The prevalence was approximately 20% in patients with obstructive airways diseases. Asthma–COPD overlap was associated with increased morbidity and possibly an increased mortality and comorbidity. There was evidence of a heterogeneous pattern of airway inflammation that included eosinophilic (in adult asthma), neutrophilic or mixed patterns (in severe asthma and COPD). Systemic inflammation was present in asthma–COPD overlap and resembled that of COPD. Within asthma–COPD overlap, there is evidence of different subgroups, and recognition using bronchodilator responsiveness has not been successful. Guidelines generally recommend a serial approach to assessment, with treatment recommendations dominated by an asthma paradigm. Research is needed into key clinical features that impact outcome, mechanisms and treatment approaches in asthma–COPD overlap. Identifying and treating disease components by multidimensional assessment shows promise.ConclusionsAsthma–COPD overlap has drawn attention to the significant heterogeneity that exists within obstructive airway diseases. It should be replaced by novel approaches that identify and manage the components of this heterogeneity, such as multidimensional assessment and treatment. Future research is needed to test these novel and personalised approaches.

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“…The number of patients overexposed to ICS may now increase, as many patients receiving high‐risk treatment would now be considered low risk and would not be indicated to use ICS . Fortunately, at least four studies of different designs have reported about the safety of ICS withdrawal among low‐risk patients . Taken together, the evidence suggests that ICS discontinuation is safe for current low‐risk patients.…”

Section: Step Down From Triple Therapy To Double Bronchodilationmentioning

confidence: 99%

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

et al. 2018

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The implementation of potential new step-up or step-down treatment recommendations in response to current guidelines is one of the main challenges currently faced in actual daily practice settings. In the present narrative review, we aim to discuss the relevance of these step-up and step-down proposals at the patient level in daily clinical practice. In particular, we aim to review the challenges associated with inhaled maintenance therapy for chronic obstructive pulmonary disease (COPD) in four clinical scenarios. First, we discuss the step up from single to double bronchodilation, including current controversies regarding the addition of a second bronchodilator versus initial treatment with two bronchodilators. Second, we discuss the step up from double bronchodilation to triple therapy while challenging current indications for inhaled steroid therapy and discussing triple therapy designs. Third, we discuss the step down from triple therapy to double bronchodilation while evaluating the effect of this downshift in risk categories on the patient according to the new classifications. Finally, we discuss the step down from double to single bronchodilation, with a special focus on safety. We believe this review will help to highlight the most relevant discussion points regarding the treatment of COPD in a manner that will stimulate and guide related clinical research.

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Withdrawal of inhaled corticosteroids can be safe in COPD patients at low risk of exacerbation: a real-life study on the appropriateness of treatment in moderate COPD patients (OPTIMO)

Cited by 119 publications

References 31 publications

Inappropriate inhaled corticosteroid prescribing in chronic obstructive pulmonary disease patients

Inappropriate inhaled corticosteroid prescribing in chronic obstructive pulmonary disease patients

Asthma-COPD overlap 2015: now we are six

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

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