Overuse of inhaled corticosteroids in COPD: five questions for withdrawal in daily practice

Didier Cataldo,1 Eric Derom,2 Giuseppe Liistro,3 Eric Marchand,4,5 Vincent Ninane,6 Rudi Peché7 Hans Slabbynck,8 Walter Vincken,9 Wim Janssens10 1Department of Respiratory Medicine, Centre Hospitalier Universitaire de Liège (CHU) and University of Liège, Liège, Belgium; 2Department of Respiratory Medicine, Ghent University Hospital, Gent, Belgium; 3Department of Respiratory Medicine, University Hospitals Saint-Luc, Brussels, Belgium; 4Department of Respiratory Medicine, University Hospital UCL Namur, Yvoir, Belgium; 5URPhyM, University of Namur, Namur, Belgium; 6Department of Respiratory Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium; 7Department of Respiratory Medicine, University Hospital Vésale, Montigny-le-Tilleul, Belgium; 8Department of Respiratory Medicine, ZNA Middelheim, Antwerpen, Belgium; 9Respiratory Division, University Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium; 10Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium Abstract: Evidence and guidelines are becoming increasingly clear about imbalance between the risks and benefits of inhaled corticosteroids (ICSs) in patients with COPD. While selected patients may benefit from ICS-containing regimens, ICSs are often inappropriately prescribed with – according to Belgian market research data – up to 70% of patients in current practice receiving ICSs, usually as a fixed combination with a long-acting β2-adrenoreceptor agonist. Studies and recommendations support withdrawal of ICSs in a large group of patients with COPD. However, historical habits appear difficult to change even in the light of recent scientific evidence. We have built a collaborative educational platform with chest physicians and primary care physicians to increase awareness and provide guidance and support in this matter. Keywords: COPD, ex