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

Respiratory Research

Review

Borja G. Cosío¹  José Antonio Quintano Jiménez²  Cruz González³  Juan Antonio Trigueros⁴  Cristóbal Esteban⁵  Marc Miravitlles⁶  José Miguel Rodríguez González-Moro⁷  Aurelio Arnedillo⁸  Myriam Calle⁹  Bernardino Alcázar-Navarrete^1,10  Adolfo Baloira^1,11 

[1] CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain;Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Spain;Centro de Salud Lucena I, Lucena, Córdoba, Spain;Department of Respiratory Medicine, Hospital Clínico Universitario and Instituto de Investigación Sanitaria (INCLIVA) Valencia, Valencia, Spain;Health Center Menasalbas, Autonomic Health Service, Toledo, Spain;Pneumology Department of Hospital Galdakao-Usansolo, Biscay, Spain;Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Bilbao, Spain;Pneumology Department, Hospital Universitari Vall d’Hebron, P. Vall d’Hebron 119-129, 08035, Barcelona, Spain;Pneumology Department, Hospital Universitary “Príncipe de Asturias”, Alcalá de Henares, Madrid, Spain;Pneumology, Allergy and Thoracic Surgery Department, Hospital Universitario Puerta del Mar, Cádiz, Spain;Medicine Department, University of Cádiz, Cádiz, Spain;Pulmonary Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain;Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain;Respiratory Department, AIG de Medicina, Hospital de Alta Resolución de Loja, Agencia Sanitaria Hospital de Poniente, Loja, Granada, Spain;Servicio de Neumología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain;

关键词: Algorithm;    Chronic obstructive pulmonary disease;    Exacerbations;    Inhaled corticosteroids;    Lung function;   

DOI  :  10.1186/s12931-017-0682-y

 received in 2017-10-23, accepted in 2017-11-15,  发布年份 2017

来源: Springer

【 摘 要 】

According to the current clinical practice guidelines for chronic obstructive pulmonary disease (COPD), the addition of inhaled corticosteroids (ICS) to long-acting β2 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.

【 授权许可】

CC BY   
© The Author(s). 2017