Investigators have proposed a tool involving a personalized approach for managing chronic obstructive pulmonary disease (COPD) and the use of inhaled corticosteroids (ICS), according to the results of a recent study published in the International Journal of Chronic Obstructive Pulmonary Disease.

The study evaluated the most recent Global Initiative for Obstructive Lung Disease (GOLD) guidelines. The guidelines recommend triple therapy—ICS, long-acting beta-2 agonists (LABAs), and long-acting muscarinic antagonists (LAMAs)—but only for patients with elevated eosinophils and exacerbations who do not experience disease control using an ICS/LABA or LABA/LAMA combination, according to the authors.

“ICS may increase the risk of side effects, including pneumonia. Thus, there remains ongoing concern over the long-term use of ICS, despite their [recommended] use when combined with long-acting bronchodilators in individuals who are at increased risk of exacerbation,” the authors wrote.

Moreover, the researchers said that the GOLD guidelines do not recommend longterm monotherapy with ICS but that it should be considered when used in association with
LABAs in patients with a history of elevated eosinophils and exacerbations.

The researchers proposed that physicians reevaluate treatment for all patients with COPD and withdraw any unnecessary treatment, suggesting specifically that physicians should consider de-escalation of ICS or a switch entirely if the patient has certain responses, such as pneumonia, or if the original indication was inappropriate.

A version of this article was originally published in American Journal of Managed Care, our sister publication. 


REFERENCE

Micheletto C, Braido F, Contoli M, Di Marco F, Santus P. A framework for step down or therapeutic re-organization for withdrawal of inhaled corticosteroids in selected patients with COPD: a proposal for COPD management. Int J Chron Obstruct Pulmon Dis. 2019;14:2185-2193. doi: 10.2147/COPD.S216059.