Inhaled Corticosteroids for Chronic Obstructive Pulmonary Disease--The Shifting Treatment Paradigm

COPD
Morven WilkieStuart Schembri

Abstract

Chronic obstructive pulmonary disease (COPD) guidelines suggest using inhaled corticosteroids (ICS) in patients with severe airflow limitation or those at high risk of exacerbations. This recommendation is based on evidence demonstrating that ICS, especially when prescribed in fixed-dose combinations (FDC) with long-acting β2 agonists (LABA), improve quality of life (QoL), decrease exacerbations and hospitalisations, and have been associated with a trend towards a reduction in all-cause mortality. Audit shows that routine prescribing practice frequently uses inhaler therapies outside current guidelines recommendations; severe to very severe disease constitutes about 20% of all COPD patients, but up to 75% of COPD patients are prescribed an ICS, with significant numbers given ICS/LABA as first-line maintenance therapy. The role of ICS in the treatment paradigm for COPD is changing, driven by the growing evidence of increased risk of pneumonia, and the introduction of a new class of FDC; LABA and long-acting muscarinic antagonists (LAMA), which simplify dual bronchodilation and present a plausible alternative therapy. As the evidence base for dual therapy bronchodilation expands, it is likely that maximal bronchodilation will mov...Continue Reading

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Citations

Aug 2, 2016·Journal of Primary Health Care·Linda Bryant
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Aug 6, 2016·The European Respiratory Journal·Claus VogelmeierAnne Leselbaum
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Aug 10, 2019·Journal of General Internal Medicine·Krysttel StryczekChristian D Helfrich
Mar 11, 2021·International Journal of Chronic Obstructive Pulmonary Disease·Jean BourbeauDavid M G Halpin

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Methods Mentioned

BETA
pharmacotherapy
TARDIS

Clinical Trials Mentioned

NCT01462942
NCT01437397
NCT01854645
NCT01854658
NCT01970878

Software Mentioned

ISOLDE
TRISTAN
ILLUMINATE
Tayside
IGNITE

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