Researchers Propose New Tool for Managing COPD and Use of Inhaled Corticosteroids

Researchers have proposed a new tool and framework involving a personalized approach for managing chronic obstructive pulmonary disease (COPD) and the use of inhaled corticosteroids (ICS), according to a recent study published in the International Journal of Chronic Obstructive Pulmonary Disease.

The study evaluated the most recent Global Initiative for Obstructive Lung Disease (GOLD) guidelines, which recommend triple therapy (long-acting β₂ agonists [LABA], long-acting muscarinic antagonists [LAMA], and ICS) but only for patients with exacerbations, elevated eosinophils, and without control using a LABA/LAMA or ICS/LABA combination, according to the authors.

“ICS may increase the risk of side effects including pneumonia. Thus, there remains ongoing concern over the long-term use of ICS, despite their [recommended] use when combined with long-acting bronchodilators in individuals who are at increased risk of exacerbation,” noted the authors. “Indeed, ICS are still routinely prescribed to the most patients with COPD at high risk of exacerbations and elevated eosinophils, even if GOLD criteria for their administration are not met.”

Moreover, the researchers emphasized that the GOLD guidelines do not recommend long-term monotherapy with ICS, but it is considered when used in association with LABAs in patients with history of exacerbations and elevated eosinophils. The researchers reviewed the available evidence on the use of ICS and created a simple management scheme to guide the management of COPD.

The study proposed that physicians reevaluate treatment for all patients with COPD and withdraw any unnecessary treatment. Then, physicians should focus on therapeutic reorganization that is personalized for each individual patient. The researchers suggest that physicians should consider de-escalation of ICS or a switch entirely if the patient has certain responses, such as pneumonia or inappropriate original indication.

“There are no international recommendations that provide specific guidance or a protocol for withdrawal of ICS. Herein, the available evidence on the use of ICS is reviewed and an easy to use tool is proposed that can provide clinicians with a simple management scheme to guide the most appropriate therapy for management of COPD and use of ICS,” the authors concluded. “In management of COPD, a highly personalized approach is advocated so that the most appropriate therapy for each individual patient can be selected.”

Reference

Micheletto C, Braido F, Contoli M, Di Marco F, Santus P. A framework for step down or therapeutic re-organization for withdrawal of inhaled corticosteroids in selected patients with COPD: a proposal for COPD management. Int J Chron Obstruct Pulmon Dis. 2019;14:2185-2193. doi: 10.2147/COPD.S216059.