Withdrawal of inhaled corticosteroids in COPD patients : Rationale and algorithms
Avdeev, S. ![ORCID Identifier](/img/uab/orcid.ico)
(Clinical Department. Federal Pulmonology Research Institute. Federal Medical and Biological Agency of Russia)
Aisanov, Z. ![ORCID Identifier](/img/uab/orcid.ico)
(Department of Pulmonology. N.I. Pirogov Russian State National Research Medical University)
Arkhipov, V. ![ORCID Identifier](/img/uab/orcid.ico)
(Department of Clinical Pharmacology and Therapy. Russian Medical Academy of Continuous Professional Education)
Belevskiy, A. (Department of Pulmonology. N.I. Pirogov Russian State National Research Medical University)
Leshchenko, I. ![ORCID Identifier](/img/uab/orcid.ico)
(Department of Phthisiology. Pulmonology and Thoracic Surgery. Ural State Medical University)
Ovcharenko, S. ![ORCID Identifier](/img/uab/orcid.ico)
(Department of Internal Diseases No.1. I.M. Sechenov First Moscow State Medical University)
Shmelev, E.
(Department of Differential Diagnostics. Federal Central Research Institute of Tuberculosis)
Miravitlles, Marc.
(Hospital Universitari Vall d'Hebron)
Universitat Autònoma de Barcelona
Date: |
2019 |
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. |
Rights: |
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, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. ![Creative Commons](/img/licenses/by-nc.ico) |
Language: |
Anglès |
Document: |
Article ; recerca ; Versió publicada |
Subject: |
COPD ;
Exacerbation ;
Inhaled corticosteroid ;
Patient follow-up ;
Guideline adherence ;
Treatment algorithm |
Published in: |
International journal of COPD, Vol. 14 (2019) , p. 1267-1280, ISSN 1178-2005 |
DOI: 10.2147/COPD.S207775
PMID: 31354256
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Record created 2020-06-03, last modified 2024-05-22