A re-evaluation of the role of inhaled corticosteroids in the management of patients with chronic obstructive pulmonary disease

Anthony D'Urzo, James F Donohue, Peter Kardos, Marc Miravitlles, David Price

Research output: Contribution to journalLiterature review

23 Citations (Scopus)
4 Downloads (Pure)

Abstract

INTRODUCTION: Inhaled corticosteroids (ICS) (in fixed combinations with long-acting β2-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.

AREAS COVERED: 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.

EXPERT OPINION: 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.

Original languageEnglish
Pages (from-to)1845-1860
Number of pages16
JournalExpert Opinion on Pharmacotherapy
Volume16
Issue number12
Early online date21 Jul 2015
DOIs
Publication statusPublished - 2015

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Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Muscarinic Antagonists
Asthma
Bronchodilator Agents
Phosphodiesterase 4 Inhibitors
Therapeutics
Anti-Inflammatory Agents
Odds Ratio
Guidelines
Drug Therapy
Population

Keywords

  • chronic obstructive pulmonary disease
  • inhaled corticosteroid
  • long-acting muscarinic antagonist
  • long-acting β2-agonist

Cite this

A re-evaluation of the role of inhaled corticosteroids in the management of patients with chronic obstructive pulmonary disease. / D'Urzo, Anthony; Donohue, James F; Kardos, Peter; Miravitlles, Marc; Price, David.

In: Expert Opinion on Pharmacotherapy, Vol. 16, No. 12, 2015, p. 1845-1860.

Research output: Contribution to journalLiterature review

D'Urzo, Anthony ; Donohue, James F ; Kardos, Peter ; Miravitlles, Marc ; Price, David. / A re-evaluation of the role of inhaled corticosteroids in the management of patients with chronic obstructive pulmonary disease. In: Expert Opinion on Pharmacotherapy. 2015 ; Vol. 16, No. 12. pp. 1845-1860.
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AB - INTRODUCTION: Inhaled corticosteroids (ICS) (in fixed combinations with long-acting β2-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.AREAS COVERED: 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.EXPERT OPINION: 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.

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