Withdrawal of inhaled corticosteroids in COPD patients

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...

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Detalles Bibliográficos
Autores: Avdeev, Sergey|||0000-0002-5999-2150, Aisanov, Zaurbek|||0000-0002-4044-674X, Arkhipov, Vladimir|||0000-0002-5671-3478, Belevskiy, Andrey|||0000-0001-6050-724X, Leshchenko, Igor|||0000-0002-1620-7159, Ovcharenko, Svetlana|||0000-0002-8264-6635, Shmelev, Evgeny|||0000-0002-1908-5601, Miravitlles, Marc.|||0000-0002-9850-9520
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:223784
Acceso en línea:https://ddd.uab.cat/record/223784
https://dx.doi.org/urn:doi:10.2147/COPD.S207775
Access Level:acceso abierto
Palabra clave:COPD
Exacerbation
Inhaled corticosteroid
Patient follow-up
Guideline adherence
Treatment algorithm
Descripción
Sumario: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.

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