POINT: Should an Attempt Be Made to Withdraw Inhaled Corticosteroids in All Patients With Stable GOLD 3 (30% ≤ FEV1 < 50% Predicted) COPD? Yes

Chest: The Journal of Circulation, Respiration and Related Systems

James D. Chalmers¹ 

关键词: GOLD;    Global Initiative for Chronic Obstructive Lung Disease;    ICS;    inhaled corticosteroid;    LABA;    long-acting β2-agonist;    LAMA;    long-acting muscarinic antagonist;   

DOI  :  10.1016/j.chest.2018.01.029

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Figures Figure 1 Current GOLD treatment recommendations. (Reproduced with permission from Vogelmeier et al.⁸) GOLD = Global Initiative for Chronic Obstructive Lung Disease; ICS = inhaled corticosteroid; LABA = long-acting β₂-agonist; LAMA = long-acting muscarinic antagonist. Figure 2 Summary of the effectiveness of ICS/LABA vs LABA on exacerbation reduction in COPD. (Reproduced with permission from the Cochrane meta-analysis [Nannini et al¹¹].) See Figure 1 legend for expansion of abbreviations. Figure 3 A schematic representation of how ICS withdrawal can be operationalized in practice. The majority of patients treated with ICS/LABA could be converted to LABA/LAMA, with those still exacerbating while receiving this regimen being escalated according to GOLD recommendations. Patients receiving triple therapy should be evaluating using exacerbation history and supported by blood eosinophil count and clinical judgment. See Figure 1 legend for expansion of abbreviations. “One of the first duties of the physician is to educate the masses not to take medicine.” (Sir William Osler, Aphorisms, 1961)

【 授权许可】

CC BY