A re-evaluation of the role of inhaled corticosteroids in the management of patients with chronic obstructive pulmonary disease. (August 2015)

• Record Type: Journal Article
• Authors: D'Urzo, Anthony; Donohue, James F; Kardos, Peter; Miravitlles, Marc; Price, David
• Is Part Of: Expert opinion on pharmacotherapy. Volume 16:Number 12(2015)
• Page Start: 1845
• Page End: 1860
• Publication Date: 2015-08
• Subjects: Chemotherapy -- Periodicals; 615.5805
• Languages: English
• ISSNs: 1465-6566

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <p> <bold> <italic>Introduction:</italic> </bold> Inhaled corticosteroids (ICS) (in fixed combinations with long-acting β<sub>2</sub>-agonists [LABAs]) are frequently prescribed for patients with chronic obstructive pulmonary disease (COPD), outside their labeled indications and recommended treatment strategies and guidelines, despite having the potential to cause significant side effects.</p> <p> <bold> <italic>Areas covered:</italic> </bold> Although the existence of asthma in patients with asthma–COPD overlap syndrome (ACOS) clearly supports the use of anti-inflammatory treatment (typically an ICS/LABA combination, as ICS monotherapy is usually not indicated for COPD), the current level of ICS/LABA use is not consistent with the prevalence of ACOS in the COPD population. Data have recently become available showing the comparative efficacy of fixed bronchodilator combinations (long-acting muscarinic antagonist [LAMA]/LABA with ICS/LABA combinations). Additionally, new information has emerged on ICS withdrawal without increased risk of exacerbations, under cover of effective bronchodilation.</p> <p> <bold> <italic>Expert opinion:</italic> </bold> For patients with COPD who do not have ACOS, a LAMA/LABA combination may be an appropriate starting therapy, apart from those with mild disease who can be managed with a single long-acting bronchodilator. Patients who remain symptomatic or present with exacerbations despite effectively delivered LAMA/LABA treatment may require additional drug therapy, such as ICS or phosphodiesterase-4 inhibitors. When prescribing an ICS/LABA, the risk:benefit ratio should be considered in individual patients.</p> </abstract>