Stepping down ICS therapy in COPDPosted on: 21 Jun 2018
PCRS has produced a guide for the evaluation of inhaled corticosteroid (ICS) therapy in COPD and guidance on appropriate ICS withdrawal.
Long-acting bronchodilators are first-line treatment for symptomatic patients with COPD at low risk of exacerbation. The addition of ICS is recommended for patients with concomitant asthma and COPD. Also, it is advocated in COPD patients with severe-to-very-severe airflow limitation and/or frequent exacerbation (two or more per year) not adequately controlled by long-acting bronchodilators. Likewise, the addition of ICS is proposed for patients who experience one or more hospitalisations for exacerbation.
In most industrialised countries, approximately 40% of patients diagnosed with COPD are candidates for ICS. This is according to criteria set by the Global Initiative for COPD. However, prescribing rates can exceed 80%. This means not only that many patients are being exposed to the risks associated with ICS, but that the cost of their care is unnecessarily high.
Therefore, it is important to know whether and how ICS treatment can be safely withdrawn.