Inhaled corticosteroids in COPD: friend or foe?

Alvar Agusti, Leonardo M. Fabbri, Dave Singh, Jørgen Vestbo, Bartolome Celli, Frits M.E. Franssen, Klaus F. Rabe, Alberto Papi

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

The efficacy, safety and positioning of inhaled corticosteroids (ICS) in the treatment of patients with chronic obstructive pulmonary disease (COPD) is much debated, since it can result in clear clinical benefits in some patients (“friend”) but can be ineffective or even associated with undesired side effects, e.g. pneumonia, in others (“foe”). After critically reviewing the evidence for and against ICS treatment in patients with COPD, we propose that: 1) ICS should not be used as a single, stand-alone therapy in COPD; 2) patients most likely to benefit from the addition of ICS to long-acting bronchodilators include those with history of multiple or severe exacerbations despite appropriate maintenance bronchodilator use, particularly if blood eosinophils are >300 cells·µL −1 , and those with a history of and/or concomitant asthma; and 3) the risk of pneumonia in COPD patients using ICS is higher in those with older age, lower body mass index (BMI), greater overall fragility, receiving higher ICS doses and those with blood eosinophils <100 cells·µL −1 . All these factors must be carefully considered and balanced in any individual COPD patient before adding ICS to her/his maintenance bronchodilator treatment. Further research is needed to clarify some of these issues and firmly establish these recommendations.

OriginalsprogEngelsk
Artikelnummer1801219
BogserieEuropean Respiratory Journal. Supplement
Vol/bind52
Udgave nummer6
Antal sider14
ISSN0903-1936
DOI
StatusUdgivet - 1. dec. 2018
Udgivet eksterntJa

Fingeraftryk

Chronic Obstructive Pulmonary Disease
Adrenal Cortex Hormones
Eosinophils
Maintenance
Body Mass Index
Safety
Research

Bibliografisk note

M1 - 1801219

Citer dette

Agusti, A., Fabbri, L. M., Singh, D., Vestbo, J., Celli, B., Franssen, F. M. E., ... Papi, A. (2018). Inhaled corticosteroids in COPD: friend or foe? European Respiratory Journal. Supplement, 52(6), [1801219]. https://doi.org/10.1183/13993003.01219-2018
Agusti, Alvar ; Fabbri, Leonardo M. ; Singh, Dave ; Vestbo, Jørgen ; Celli, Bartolome ; Franssen, Frits M.E. ; Rabe, Klaus F. ; Papi, Alberto. / Inhaled corticosteroids in COPD : friend or foe?. I: European Respiratory Journal. Supplement. 2018 ; Bind 52, Nr. 6.
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title = "Inhaled corticosteroids in COPD: friend or foe?",
abstract = "The efficacy, safety and positioning of inhaled corticosteroids (ICS) in the treatment of patients with chronic obstructive pulmonary disease (COPD) is much debated, since it can result in clear clinical benefits in some patients (“friend”) but can be ineffective or even associated with undesired side effects, e.g. pneumonia, in others (“foe”). After critically reviewing the evidence for and against ICS treatment in patients with COPD, we propose that: 1) ICS should not be used as a single, stand-alone therapy in COPD; 2) patients most likely to benefit from the addition of ICS to long-acting bronchodilators include those with history of multiple or severe exacerbations despite appropriate maintenance bronchodilator use, particularly if blood eosinophils are >300 cells·µL −1 , and those with a history of and/or concomitant asthma; and 3) the risk of pneumonia in COPD patients using ICS is higher in those with older age, lower body mass index (BMI), greater overall fragility, receiving higher ICS doses and those with blood eosinophils <100 cells·µL −1 . All these factors must be carefully considered and balanced in any individual COPD patient before adding ICS to her/his maintenance bronchodilator treatment. Further research is needed to clarify some of these issues and firmly establish these recommendations.",
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Agusti, A, Fabbri, LM, Singh, D, Vestbo, J, Celli, B, Franssen, FME, Rabe, KF & Papi, A 2018, 'Inhaled corticosteroids in COPD: friend or foe?', European Respiratory Journal. Supplement, bind 52, nr. 6, 1801219. https://doi.org/10.1183/13993003.01219-2018

Inhaled corticosteroids in COPD : friend or foe? / Agusti, Alvar; Fabbri, Leonardo M.; Singh, Dave; Vestbo, Jørgen; Celli, Bartolome; Franssen, Frits M.E.; Rabe, Klaus F.; Papi, Alberto.

I: European Respiratory Journal. Supplement, Bind 52, Nr. 6, 1801219, 01.12.2018.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Inhaled corticosteroids in COPD

T2 - friend or foe?

AU - Agusti, Alvar

AU - Fabbri, Leonardo M.

AU - Singh, Dave

AU - Vestbo, Jørgen

AU - Celli, Bartolome

AU - Franssen, Frits M.E.

AU - Rabe, Klaus F.

AU - Papi, Alberto

N1 - M1 - 1801219

PY - 2018/12/1

Y1 - 2018/12/1

N2 - The efficacy, safety and positioning of inhaled corticosteroids (ICS) in the treatment of patients with chronic obstructive pulmonary disease (COPD) is much debated, since it can result in clear clinical benefits in some patients (“friend”) but can be ineffective or even associated with undesired side effects, e.g. pneumonia, in others (“foe”). After critically reviewing the evidence for and against ICS treatment in patients with COPD, we propose that: 1) ICS should not be used as a single, stand-alone therapy in COPD; 2) patients most likely to benefit from the addition of ICS to long-acting bronchodilators include those with history of multiple or severe exacerbations despite appropriate maintenance bronchodilator use, particularly if blood eosinophils are >300 cells·µL −1 , and those with a history of and/or concomitant asthma; and 3) the risk of pneumonia in COPD patients using ICS is higher in those with older age, lower body mass index (BMI), greater overall fragility, receiving higher ICS doses and those with blood eosinophils <100 cells·µL −1 . All these factors must be carefully considered and balanced in any individual COPD patient before adding ICS to her/his maintenance bronchodilator treatment. Further research is needed to clarify some of these issues and firmly establish these recommendations.

AB - The efficacy, safety and positioning of inhaled corticosteroids (ICS) in the treatment of patients with chronic obstructive pulmonary disease (COPD) is much debated, since it can result in clear clinical benefits in some patients (“friend”) but can be ineffective or even associated with undesired side effects, e.g. pneumonia, in others (“foe”). After critically reviewing the evidence for and against ICS treatment in patients with COPD, we propose that: 1) ICS should not be used as a single, stand-alone therapy in COPD; 2) patients most likely to benefit from the addition of ICS to long-acting bronchodilators include those with history of multiple or severe exacerbations despite appropriate maintenance bronchodilator use, particularly if blood eosinophils are >300 cells·µL −1 , and those with a history of and/or concomitant asthma; and 3) the risk of pneumonia in COPD patients using ICS is higher in those with older age, lower body mass index (BMI), greater overall fragility, receiving higher ICS doses and those with blood eosinophils <100 cells·µL −1 . All these factors must be carefully considered and balanced in any individual COPD patient before adding ICS to her/his maintenance bronchodilator treatment. Further research is needed to clarify some of these issues and firmly establish these recommendations.

KW - Administration, Inhalation

KW - Adrenal Cortex Hormones/administration & dosage

KW - Adrenergic beta-2 Receptor Agonists/therapeutic use

KW - Age Factors

KW - Bronchodilator Agents/therapeutic use

KW - Disease Progression

KW - Drug Therapy, Combination

KW - Eosinophils/cytology

KW - Humans

KW - Pneumonia/etiology

KW - Pulmonary Disease, Chronic Obstructive/complications

U2 - 10.1183/13993003.01219-2018

DO - 10.1183/13993003.01219-2018

M3 - Journal article

C2 - 30190269

VL - 52

JO - European Respiratory Journal. Supplement

JF - European Respiratory Journal. Supplement

SN - 0904-1850

IS - 6

M1 - 1801219

ER -