title: "Real-life" inhaled corticosteroid withdrawal in COPD: a subgroup analysis of DACCORD.
abstract: Many patients with chronic obstructive pulmonary disease (COPD) receive inhaled corticosteroids (ICSs) without a clear indication, and thus, the impact of ICS withdrawal on disease control is of great interest. DACCORD is a prospective, noninterventional 2-year study in the primary and secondary care throughout Germany. A subgroup of patients were taking ICS prior to entry - 1,022 patients continued to receive ICS for 2 years; physicians withdrew ICS on entry in 236 patients. Data from these two subgroups were analyzed to evaluate the impact of ICS withdrawal. Patients aged ≥40 years with COPD, initiating or changing COPD maintenance medication were recruited, excluding patients with asthma. Demographic and disease characteristics, prescribed COPD medication, COPD Assessment Test, exacerbations, and lung function were recorded. There were few differences in baseline characteristics; ICS withdrawn patients had shorter disease duration and better lung function, with 74.2% of ICS withdrawn patients not exacerbating, compared with 70.7% ICS-continued patients. During Year 1, exacerbation rates were 0.414 in the withdrawn group and 0.433 in the continued group. COPD Assessment Test total score improved from baseline in both groups. These data suggest that ICS withdrawal is possible with no increased risk of exacerbations in patients with COPD managed in the primary and secondary care.
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg.
authors.forename: Claus
authors.initials: C
authors.lastname: Vogelmeier
authors.affiliation: Facharzt Forum Fürth, Fürth.
authors.forename: Heinrich
authors.initials: H
authors.lastname: Worth
authors.affiliation: Pulmonary Department, Mainz University Hospital, Mainz.
authors.forename: Roland
authors.initials: R
authors.lastname: Buhl
authors.affiliation: Department of Sleep and Respiratory Medicine, Evangelical Hospital Göttingen-Weende, Bovenden.
authors.forename: Carl-Peter
authors.initials: CP
authors.lastname: Criée
authors.affiliation: Clinical Research, Respiratory, Novartis Pharma GmbH, Nürnberg.
authors.forename: Nadine S
authors.initials: NS
authors.lastname: Lossi
authors.affiliation: Clinical Research, Respiratory, Novartis Pharma GmbH, Nürnberg.
authors.forename: Claudia
authors.initials: C
authors.lastname: Mailänder
authors.affiliation: Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Frankfurt am Main, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kardos
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects; D018450:Disease Progression; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005858:Germany; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D020127:Recovery of Function; D012042:Registries; D012307:Risk Factors; D063127:Secondary Health Care; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D004338:Drug Combinations
keywords: COPD exacerbations; chronic obstructive pulmonary disease exacerbations; health-related quality of life; inhaled steroids