A proposal for the withdrawal of inhaled corticosteroids in the clinical practice of chronic obstructive pulmonary disease

Abstract

According to the current clinical practice guidelines for chronic obstructive pulmonary disease (COPD), the addition of inhaled corticosteroids (ICS) to long-acting β ₂ agonist therapy is recommended in patients with moderate-to-severe disease and an increased risk of exacerbations. However, ICS are largely overprescribed in clinical practice, and most patients are unlikely to benefit from long-term ICS therapy.

Evidence from recent randomized-controlled trials supports the hypothesis that ICS can be safely and effectively discontinued in patients with stable COPD and in whom ICS therapy may not be indicated, without detrimental effects on lung function, health status, or risk of exacerbations. This article summarizes the evidence supporting the discontinuation of ICS therapy, and proposes an algorithm for the implementation of ICS withdrawal in patients with COPD in clinical practice.

Given the increased risk of potentially serious adverse effects and complications with ICS therapy (including pneumonia), the use of ICS should be limited to the minority of patients in whom the treatment effects outweigh the risks.

Contributors

Marc Miravitlles:

ORCID: http://orcid.org/0000-0002-9850-9520

[phone] , [e-mail]

Journal

Journal ID (nlm-ta): Respir Res

Journal ID (iso-abbrev): Respir. Res

Title: Respiratory Research

Publisher: BioMed Central (London )

ISSN (Print): 1465-9921

ISSN (Electronic): 1465-993X

Publication date (Electronic): 28 November 2017

Publication date PMC-release: 28 November 2017

Publication date (Print): 2017

Volume: 18

Affiliations

[1 ]ISNI 0000 0001 0675 8654, GRID grid.411083.f, Pneumology Department, , Hospital Universitari Vall d’Hebron, ; P. Vall d’Hebron 119-129, 08035 Barcelona, Spain

[2 ]ISNI 0000 0000 9314 1427, GRID grid.413448.e, CIBER de Enfermedades Respiratorias (CIBERES), ; Barcelona, Spain

[3 ]ISNI 0000 0004 1796 5984, GRID grid.411164.7, Department of Respiratory Medicine, , Hospital Universitario Son Espases-IdISBa, ; Palma de Mallorca, Spain

[4 ]ISNI 0000 0004 1771 1175, GRID grid.411342.1, Pneumology, Allergy and Thoracic Surgery Department, , Hospital Universitario Puerta del Mar, ; Cádiz, Spain

[5 ]ISNI 0000000103580096, GRID grid.7759.c, Medicine Department, , University of Cádiz, ; Cádiz, Spain

[6 ]ISNI 0000 0001 0671 5785, GRID grid.411068.a, Pulmonary Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), , Hospital Clínico San Carlos, ; Madrid, Spain

[7 ]ISNI 0000 0001 2157 7667, GRID grid.4795.f, Departamento de Medicina, Facultad de Medicina, , Universidad Complutense de Madrid, ; Madrid, Spain

[8 ]Respiratory Department, AIG de Medicina, Hospital de Alta Resolución de Loja, Agencia Sanitaria Hospital de Poniente, Loja, Granada Spain

[9 ]GRID grid.411308.f, Department of Respiratory Medicine, , Hospital Clínico Universitario and Instituto de Investigación Sanitaria (INCLIVA) Valencia, ; Valencia, Spain

[10 ]Pneumology Department of Hospital Galdakao-Usansolo, Biscay, Spain

[11 ]Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain

[12 ]Health Center Menasalbas, Autonomic Health Service, Toledo, Spain

[13 ]ISNI 0000 0004 1765 5855, GRID grid.411336.2, Pneumology Department, , Hospital Universitary “Príncipe de Asturias”, Alcalá de Henares, ; Madrid, Spain

[14 ]Centro de Salud Lucena I, Lucena, Córdoba, Spain

[15 ]Servicio de Neumología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain

Article

Publisher ID: 682

DOI: 10.1186/s12931-017-0682-y

PMC ID: 5706374

PubMed ID: 29183382

Copyright statement: © The Author(s). 2017

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100004336, Novartis;

Categories

Subject: Review

Custom metadata

issue-copyright-statement © The Author(s) 2017