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Review
, 14, 1267-1280
eCollection

Withdrawal of Inhaled Corticosteroids in COPD Patients: Rationale and Algorithms

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Review

Withdrawal of Inhaled Corticosteroids in COPD Patients: Rationale and Algorithms

Sergey Avdeev et al. Int J Chron Obstruct Pulmon Dis.

Abstract

Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

Keywords: COPD; exacerbation; guideline adherence; inhaled corticosteroid; patient follow-up; treatment algorithm.

Conflict of interest statement

Professor Dr Sergey Avdeev has received speaker/consultancy fees from Boehringer Ingelheim, AstraZeneca, Chiesi, Teva, and Novartis; and research grants from AstraZeneca, GlaxoSmithKline, and Novartis, outside the submitted work. Professor Dr Zaurbek Aisanov has received speaker/consultancy fees from Boehringer Ingelheim, AstraZeneca, Chiesi, Teva, Novartis, and GlaxoSmithKline; and research grants from AstraZeneca, GlaxoSmithKline, and Novartis, outside the submitted work. Professor Dr Vladimir Arkhipov has received speaker/consultancy fees from Boehringer Ingelheim, AstraZeneca, Chiesi, Teva, and Astrllas; non-financial support from Boehringer Ingelheim; and research grants from AstraZeneca, outside the submitted work. Professor Dr Andrey Belevskiy has received speaker/consultancy fees from Boehringer Ingelheim, AstraZeneca, Chiesi, and Novartis, outside the submitted work. Professor Dr Igor Leshchenko has received speaker/consultancy fees from Boehringer Ingelheim, AstraZeneca, Chiesi, Teva, and Novartis, outside the submitted work. Professor Dr Svetlana Ovcharenkohas received speaker/consultancy fees from AstraZeneca, Boehringer Ingelheim, Chiesi, and Novartis, outside the submitted work. Professor Dr Evgeny Shmelev has received speaker/consultancy fees from Boehringer Ingelheim, AstraZeneca, Chiesi, Roche, Teva, and Novartis, outside the submitted work. Dr Marc Miravitlles has received speaker fees from Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, CSL Behring, Grifols, and Novartis; consultancy fees from Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, CSL Behring, Laboratories Esteve, Mereo BioPharm, Verona Pharma, pH Pharma, Novartis, and Grifols; and research grants from GlaxoSmithKline and Grifols, outside the submitted work.

Figures

Figure 1
Figure 1
A proposed algorithm for ICS withdrawal in patients with COPD. Abbreviations: BA, bronchial asthma; CAP, community-acquired pneumonia; COPD, chronic obstructive pulmonary disease; EOS, eosinophils; ICS, inhaled corticosteroid; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist.

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