Rebuttal From Dr Pavord
I find myself agreeing with almost all of Professor Chalmer’s comments. I accept that this is not in the spirit of a pro-con debate, but suggest it represents much more important and exciting development: an emerging consensus on the use of inhaled corticosteroids (ICS) in patients with COPD. We bot...
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| Format: | Journal article |
| Language: | English |
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Elsevier
2018
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| Summary: | I find myself agreeing with almost all of Professor Chalmer’s comments. I accept that this is not in the spirit of a pro-con debate, but suggest it represents much more important and exciting development: an emerging consensus on the use of inhaled corticosteroids (ICS) in patients with COPD. We both recommend that treatment is initiated in patients who have evidence of involvement the relevant biological pathway rather than those who possess an arbitrary label. We agree that in the blood eosinophil count we have a convenient and reasonably robust biomarker of corticosteroid responsive eosinophilic airway inflammation. As the main impact of treatment is to reduce the frequency of exacerbations (particularly those requiring treatment with oral corticosteroids) and as prior exacerbations are the most important predictor of future events, we also agree that ICS should be applied in a secondary prevention type fashion. |
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