A proposal for the withdrawal of inhaled corticosteroids in the clinical practice of chronic obstructive pulmonary disease
Miravitlles, Marc (Hospital Universitari Vall d'Hebron)
Cosio, Borja G.. (Institut d'Investigació Sanitària Illes Balears)
Arnedillo, Aurelio (Universidad de Cádiz)
Calle Rubio, Myriam (Universidad Complutense de Madrid)
Alcázar-Navarrete, Bernardino (Hospital de Alta Resolución de Loja)
González, Cruz (Hospital Clínic Universitari (València))
Esteban, Cristóbal (Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas)
Trigueros, Juan Antonio (Centro de Salud Menasalbas)
Rodríguez González-Moro, José Miguel (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
Quintano Jiménez, José Antonio (Centro de Salud Lucena I, Lucena, Córdoba, Spain)
Baloira, Adolfo (Complejo Hospitalario Universitario de Pontevedra)
Universitat Autònoma de Barcelona

Data:	2017
Resum:	According to the current clinical practice guidelines for chronic obstructive pulmonary disease (COPD), the addition of inhaled corticosteroids (ICS) to long-acting β agonist therapy is recommended in patients with moderate-to-severe disease and an increased risk of exacerbations. However, ICS are largely overprescribed in clinical practice, and most patients are unlikely to benefit from long-term ICS therapy. Evidence from recent randomized-controlled trials supports the hypothesis that ICS can be safely and effectively discontinued in patients with stable COPD and in whom ICS therapy may not be indicated, without detrimental effects on lung function, health status, or risk of exacerbations. This article summarizes the evidence supporting the discontinuation of ICS therapy, and proposes an algorithm for the implementation of ICS withdrawal in patients with COPD in clinical practice. Given the increased risk of potentially serious adverse effects and complications with ICS therapy (including pneumonia), the use of ICS should be limited to the minority of patients in whom the treatment effects outweigh the risks.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Algorithm ; Chronic obstructive pulmonary disease ; Exacerbations ; Inhaled corticosteroids ; Lung function
Publicat a:	Respiratory Research, Vol. 18 (november 2017) , ISSN 1465-993X

DOI: 10.1186/s12931-017-0682-y
PMID: 29183382

11 p, 594.6 KB

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