Appropriate use of inhaled corticosteroids in COPD: the candidates for safe withdrawal.
International guidance on chronic obstructive pulmonary disease (COPD) management recommends the use of inhaled corticosteroids (ICS) in those patients at increased likelihood of exacerbation. In spite of this guidance, ICS are prescribed in a large number of patients who are unlikely to benefit. Given the evidence of the risks associated with ICS and the limited indications for their use, there is interest in understanding the effects of withdrawing ICS when prescribed inappropriately. In this review, we discuss the findings of large ICS withdrawal trials, with primary focus on the more recent trials using active comparators. Data from these trials indicate that ICS may be withdrawn without adverse impact on exacerbation risk and patient-reported outcomes in patients with moderate COPD and no history of frequent exacerbations. Considering the safety concerns associated with ICS use, these medications should be withdrawn in patients for whom they are not recommended, while maintaining adequate bronchodilator therapy.
Department of Family and Community Health, University of Minnesota, Rochester, MN, USA.
Barbara P
BP
Yawn
Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.|Department of Epidemiology and Biostatistics and Department of Medicine, McGill University, Montreal, QC, Canada.
Samy
S
Suissa
Pulmonary Unit, University and General Hospital, Verona, Italy.
Andrea
A
Rossi
Chest. 2004 Jul;126(1):220-37
15249466
Chest. 2015 Nov;148(5):1177-83
26110239
BMJ. 2000 May 13;320(7245):1297-303
10807619
Thorax. 2003 Nov;58(11):937-41
14586043
BMC Pulm Med. 2014 Apr 02;14:56
24694050
Rev Mal Respir. 2010;27(1):11-8
20146947
Am J Respir Crit Care Med. 2006 Apr 15;173(8):842-6
16439716
N Engl J Med. 2014 Oct 2;371(14):1285-94
25196117
Respir Med. 2014 May;108(5):729-36
24675239
Lancet. 2000 Oct 28;356(9240):1480-5
11081531
Cochrane Database Syst Rev. 2014 Mar 10;(3):CD010115
24615270
Eur Respir J. 2013 Nov;42(5):1391-401
23645406
N Engl J Med. 2015 Jan 1;372(1):93
25551538
Prim Care Respir J. 2006 Feb;15(1):48-57
16701758
Can Respir J. 2008 Jan-Feb;15(1):13-9
18292848
Respir Res. 2014 Jul 08;15:77
25005873
Am J Respir Crit Care Med. 2007 Sep 1;176(5):454-9
17556723
QJM. 2010 Jun;103(6):379-85
20231237
Eur Respir J. 2008 Jul;32(1):17-24
18591336
COPD. 2005 Mar;2(1):75-9
17136966
J Gen Intern Med. 2011 Feb;26(2):192-6
20857339
Am J Respir Crit Care Med. 2008 Aug 15;178(4):332-8
18511702
Eur Respir J. 2008 May;31(5):927-33
18216056
Am J Respir Crit Care Med. 2008 Jun 1;177(11):1207-14
18310480
Int J Chron Obstruct Pulmon Dis. 2014 Aug 27;9:889-904
25210450
Chest. 2015 Apr;147(4):894-942
25321320
Am J Respir Crit Care Med. 2002 Nov 15;166(10):1358-63
12406823
Curr Med Res Opin. 2011 Jul;27(7):1425-9
21599554
Eur Respir J. 2002 Jan;19(1):182-91
11843317
N Engl J Med. 2000 Dec 28;343(26):1902-9
11136260
Respir Med. 2012 Jul;106(7):989-97
22483189
Thorax. 2013 Nov;68(11):1029-36
24130228
Respir Med. 1999 Mar;93(3):161-6
10464871
Lancet Respir Med. 2013 Mar;1(1):51-60
24321804
Swiss Med Wkly. 2010 Apr 21;:null
20407960
Thorax. 2005 Jun;60(6):480-7
15923248
Eur Respir J. 2014 Apr;43(4):1201-3
24176996
Ann Am Thorac Soc. 2015 Jan;12(1):27-34
25490706
Eur Respir J. 2015 Nov;46(5):1232-5
26521271
N Engl J Med. 2015 Jan 1;372(1):92
25551536
Thorax. 1999 Jan;54(1):7-14
10343624
Lancet Respir Med. 2013 May;1(3):199-209
24429126
Eur Respir J. 2015 Feb;45(2):525-37
25537556
Eur Respir J. 2014 Dec;44(6):1548-56
25359348
Am J Respir Crit Care Med. 2008 Jan 1;177(1):19-26
17916806
Prim Care Respir J. 2013 Mar;22(1):92-100
23135217
Int J Chron Obstruct Pulmon Dis. 2013;8:295-304
23836970
Chest. 2009 Oct;136(4):1095-100
19809050
Arch Bronconeumol. 2012 Jul;48(7):247-57
22561012
Respir Res. 2007 Dec 27;8:93
18162137
Int J Chron Obstruct Pulmon Dis. 2010 Aug 09;5:241-9
20714378