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Withdrawal of inhaled corticosteroids in COPD patients: rationale and algorithms

Authors :
Marc Miravitlles
E. I. Shmelev
Igor Leshchenko
Andrey Belevskiy
Zaurbek Aisanov
Svetlana Ovcharenko
Sergey Avdeev
V. V. Arkhipov
Source :
International Journal of Chronic Obstructive Pulmonary Disease. 14:1267-1280
Publication Year :
2019
Publisher :
Informa UK Limited, 2019.

Abstract

Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

Details

ISSN :
11782005
Volume :
14
Database :
OpenAIRE
Journal :
International Journal of Chronic Obstructive Pulmonary Disease
Accession number :
edsair.doi...........00a315bc999499e8152bcf4805f167b8
Full Text :
https://doi.org/10.2147/copd.s207775