Withdrawal of Inhaled Corticosteroids in Patients with COPD – A Prospective Observational Study

Abstract

Background Inhaled corticosteroids (ICS) are widely used in the treatment of chronic obstructive pulmonary disease (COPD), but recent studies have raised doubts whether all COPD patients will benefit from ICS. This study evaluates in a real-life setting the effects of ICS withdrawal in patients with COPD. Methods The study was a prospective intervention study following patients with COPD for 6 months after abrupt withdrawal of ICS. FEV1 (L), blood eosinophilic count (x10E9/L) and number of exacerbations were measured at baseline, 1, 3 and 6 months after ICS withdrawal. Results Ninety-six patients (56 females (57.4%), mean age 70 years (51–94 years)) with COPD were included in the study. Eleven patients were excluded during the study period (7 patients died, 4 patients withdrew their consent during the study period). During the 6 months, 51 patients (60%) had resumed treatment with ICS, of whom 34 patients (68%) experienced an exacerbation during follow-up. No significant decline in FEV1 was seen in this group between baseline and after 6 months (ΔFEV1 0.07 L, p = 0.09). In the remaining 34 patients (40%) without ICS after 6 months of follow-up, 15 patients (44.1%) experienced an exacerbation. No significant decline was seen in FEV1 at baseline and after 6 months (ΔFEV1 0.04 L, p = 0.28). There were no statistically significant differences between the two groups in age (70.5 vs 69.6 years, p = 0.53), nor between FEV1 at baseline (0.96 L vs 1.00 L, p = 0.63) or eosinophilic count (0.25 x10E9/L vs 0.17 x10E9/L, p = 0.07). Conclusion Abrupt withdrawal of ICS was possible in some patients. However, more than half of the patients resumed ICS during follow-up. Based on results from our study we were not able to foresee – from neither history of exacerbations nor eosinophilic count – whom will be able to manage without ICS and who will resume treatment with ICS.

A systematic review of blood eosinophils and continued treatment with inhaled corticosteroids in patients with COPD

“…The withdrawal of ICS in patients with a low EOS count may be hindered by both patient and provider resistance. In a recent real-life study by Nielsen et al, 96 consecutive patients with COPD had their ICS treatment abruptly withdrawn [44]. Although lasting withdrawal was possible in some patients, more than half resumed ICS irrespective of history of exacerbations and eosinophilic count.…”

Clinical and Economic Impact of Long-Term Inhaled Corticosteroid Withdrawal in Patients with Chronic Obstructive Pulmonary Disease Treated with Triple Therapy in Spain

“…In two recent real-life studies, Magnussen et al 34 found that discontinuation of ICS was not associated with an increased risk of exacerbation in primary care patients with very few exacerbations, but ICS should not be withdrawn in a subgroup of patients with frequent oral corticosteroid cycles and elevated blood eosinophil counts due to the risk of exacerbations. In a 6-month follow-up study after ICS withdrawal, Nielsen et al 35 found that 60% of patients resumed ICS due to exacerbations. Our results show we were unable to predict the patients who could benefit from the withdrawal or continuation of ICS according to the rate of exacerbations or the eosinophil count.…”

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

“…Chronic Obstructive Pulmonary Disease (COPD) is a progressive chronic disease characterized by irreversible, fixed airways obstruction, progressive destruction of lung parenchyma and airways inflammation. 1 Mucus hypersecretion and narrowing of the airways 2 contribute to symptoms including excessive sputum production, dyspnoea and chronic cough 3 punctuated by episodes of acute worsening of symptoms known as exacerbations. 4 The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 guidelines recommend that the mainstay of treatment for COPD patients includes long-acting muscarinic antagonists (LAMA) and long-acting beta agonists (LABA).…”