Escalation and De-escalation of Therapy in COPD: Myths, Realities and Perspectives

Drugs
M CazzolaM G Matera

Abstract

Chronic obstructive pulmonary disease (COPD) guidelines and strategies suggest escalating treatment, mainly depending on the severity of airflow obstruction. However, some de-escalation of therapy in COPD would be appropriate, although we still do not know when we should switch, step-up or step-down treatments in our patients. Unfortunately, trials comparing different strategies of step-up and step-down treatment (e.g. treatment initiation with one single agent and then further step-up if symptoms are not controlled versus initial use of double or triple therapy, possibly with lower doses of the individual components, or the role of N-acetylcysteine in combination therapy for a step-down approach) are still lacking. In general, there is a large and often inappropriate use of the inhaled corticosteroid (ICS)/long-acting β2-agonist (LABA) combination. However, the withdrawal of the ICS in COPD patients at low risk of exacerbation can be safe, provided that patients are under regular treatment with long-acting bronchodilators. Maximising the treatment in patients with a degree of clinical instability by including an ICS in the therapeutic regimen is useful to control the disease, but may not be needed during periods of clinical st...Continue Reading

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Citations

Nov 17, 2015·Expert Review of Respiratory Medicine·Maria Gabriella MateraMario Cazzola
Feb 20, 2016·Expert Opinion on Pharmacotherapy·Mario CazzolaMaria Gabriella Matera
May 14, 2016·Expert Opinion on Drug Discovery·Mario CazzolaMaria Gabriella Matera
Oct 31, 2017·Expert Review of Respiratory Medicine·Mario CazzolaMaria Gabriella Matera
May 3, 2018·Expert Opinion on Drug Safety·Paola RoglianiLuigino Calzetta
Feb 2, 2019·Expert Opinion on Pharmacotherapy·Paola RoglianiJosuel Ora
Jul 1, 2020·Expert Review of Clinical Pharmacology·Luigino CalzettaMario Cazzola
Sep 5, 2020·Expert Review of Clinical Pharmacology·Paola RoglianiLuigino Calzetta
Dec 19, 2019·Pharmacological Reviews·M G MateraM Cazzola
Mar 2, 2017·Molecular Diagnosis & Therapy·Mario CazzolaMaria Gabriella Matera
Oct 5, 2019·Canadian Respiratory Journal : Journal of the Canadian Thoracic Society·Pierachille SantusDejan Radovanovic
Oct 8, 2020·Drugs·Mario CazzolaMaria Gabriella Matera

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