Counterpoint: Should an attempt be made to withdraw inhaled corticosteroids in all patients with stable GOLD 3 (30% ≤ FEV1 < 50% predicted) COPD? No.
Inhaled corticosteroids (ICS) have been accepted by successive GOLD documents as being effective agents for the prevention of COPD exacerbations and decline in health status. The combination of an ICS and a long-acting beta-agonist (LABA) is superior to the LABA alone in achieving these positive ben...
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| Format: | Journal article |
| Language: | English |
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Elsevier
2018
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| Summary: | Inhaled corticosteroids (ICS) have been accepted by successive GOLD documents as being effective agents for the prevention of COPD exacerbations and decline in health status. The combination of an ICS and a long-acting beta-agonist (LABA) is superior to the LABA alone in achieving these positive benefits. As the major effect of adding ICS is to reduce exacerbations, conventional guidance suggests this treatment in patients with a history of prior exacerbations. However, there has been a reappraisal of the use of ICS mainly driven by two factors: the recognition that treatment is associated with important adverse events, best documented in clinical trials as an approximately doubling of the risk of pneumonia; and the demonstration in a large and influential clinical trial that combined LABA and long acting antimuscarinic (LAMA) treatment has a larger positive impact on exacerbations, symptoms and lung function and is less likely to be associated with pneumonia than treatment with LABA/ICS. As a result GOLD 2017 recommends LABA/LAMA as a primary exacerbation reduction strategy and a more restricted role for ICS. |
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