title: "Correct use of inhaled corticosteroids in chronic obstructive pulmonary disease": a consensus document.
abstract: BACKGROUND
  Indications for inhaled corticosteroids (IC) in combination with long-acting bronchodilators (LABD) are well defined in clinical practice guidelines. However, there are some doubts about their efficacy and safety. The aim of this document is to establish an expert consensus to clarify these issues.
  
  
  METHODS
  A coordinator group was formed, which systematically reviewed the scientific evidence with the aim of identifying areas of uncertainty about the efficacy of ICs, the adverse effects associated with their use and criteria for withdrawal. Their proposals were submitted to a panel of experts and the Delphi technique was used to test the level of consensus.
  
  
  RESULTS
  Twenty-five experts participated in the panel, and consensus was reached on the use of IC in the mixed chronic obstructive pulmonary disease (COPD)-asthma phenotype and in frequent exacerbators, and on not using IC in association with LABD for improving lung function in COPD. There was no general consensus on restricting the use of IC to prevent adverse effects. The panel did agree that IC withdrawal is feasible but should be undertaken gradually, and patients who have discontinued must be evaluated in the short term.
  
  
  CONCLUSIONS
  Consensus was reached regarding the indication of IC in mixed COPD-asthma and frequent exacerbator phenotypes. The potential for adverse effects must be taken into consideration, but there is no consensus on whether limiting use is justified. The withdrawal of ICs was uniformly agreed to be feasible.
authors.affiliation: Neumología, Área integrada de gestión de Medicina, Hospital de Alta Resolución de Loja, APES Hospital de Poniente, Granada, España. Electronic address: balcazar@telefonica.net.
authors.forename: Bernardino
authors.initials: B
authors.lastname: Alcázar Navarrete
authors.affiliation: Servicio de Neumología, Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, España.
authors.forename: Ciro
authors.initials: C
authors.lastname: Casanova
authors.affiliation: Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, España.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.affiliation: Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: Pilar
authors.initials: P
authors.lastname: de Lucas
authors.affiliation: Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Riesco
authors.affiliation: Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Rodríguez González-Moro
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018450:Disease Progression; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D010641:Phenotype; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013183:Sputum / Q000166:cytology
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists
keywords: Chronic obstructive pulmonary disease; Corticoides inhalados; Enfermedad pulmonar obstructiva crónica; Guidelines; Inhaled corticosteroids; Normativas