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Corticosteroids withdrawal COPD

Claus Vogelmeier, Heinrich Worth, Roland Buhl, Carl-Peter Criée, Nadine S Lossi, Claudia Mailänder, Peter Kardos
Many patients with chronic obstructive pulmonary disease (COPD) receive inhaled corticosteroids (ICSs) without a clear indication, and thus, the impact of ICS withdrawal on disease control is of great interest. DACCORD is a prospective, noninterventional 2-year study in the primary and secondary care throughout Germany. A subgroup of patients were taking ICS prior to entry - 1,022 patients continued to receive ICS for 2 years; physicians withdrew ICS on entry in 236 patients. Data from these two subgroups were analyzed to evaluate the impact of ICS withdrawal...
2017: International Journal of Chronic Obstructive Pulmonary Disease
Lisette I Z Kunz, Nick H T Ten Hacken, Thérèse S Lapperre, Wim Timens, Huib A M Kerstjens, Annemarie van Schadewijk, Judith M Vonk, Jacob K Sont, Jiska B Snoeck-Stroband, Dirkje S Postma, Peter J Sterk, Pieter S Hiemstra
Long-term treatment with inhaled corticosteroids (ICS) might attenuate lung function decline and decrease airway inflammation in a subset of patients with chronic obstructive pulmonary disease (COPD), and discontinuing ICS treatment could result in further lung function decline. We hypothesised that airway inflammation increases after ICS withdrawal following long-term ICS treatment in COPD.In the GLUCOLD-1 study (GL1), 114 patients with moderate-severe COPD were randomised to 6-month or 30-month treatment with fluticasone propionate (500 µg twice daily), 30-month treatment with fluticasone/salmeterol (500/50 µg twice daily) or placebo...
January 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
Barbara P Yawn, Samy Suissa, Andrea Rossi
International guidance on chronic obstructive pulmonary disease (COPD) management recommends the use of inhaled corticosteroids (ICS) in those patients at increased likelihood of exacerbation. In spite of this guidance, ICS are prescribed in a large number of patients who are unlikely to benefit. Given the evidence of the risks associated with ICS and the limited indications for their use, there is interest in understanding the effects of withdrawing ICS when prescribed inappropriately. In this review, we discuss the findings of large ICS withdrawal trials, with primary focus on the more recent trials using active comparators...
September 29, 2016: NPJ Primary Care Respiratory Medicine
Roberto Rodriguez-Roisin, Kay Tetzlaff, Henrik Watz, Emiel Fm Wouters, Bernd Disse, Helen Finnigan, Helgo Magnussen, Peter Ma Calverley
The WISDOM study (NCT00975195) reported a change in lung function following withdrawal of fluticasone propionate in patients with severe to very severe COPD treated with tiotropium and salmeterol. However, little is known about the validity of home-based spirometry measurements of lung function in COPD. Therefore, as part of this study, following suitable training, patients recorded daily home-based spirometry measurements in addition to undergoing periodic in-clinic spirometric testing throughout the study duration...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Wei Du, Jinyu Su, Dan Ye, Yuegang Wang, Qiaobing Huang, Xiaowei Gong
Inhaled corticosteroids (ICS) are widely used to manage chronic obstructive pulmonary disease (COPD). However, withdrawal of ICS generally causes various adverse effects, warranting careful management of the ICS withdrawal. Pinellia ternata, a traditional Chinese herbal medicine, has been used to treat respiratory diseases in China for centuries. Here, we investigated its role in antagonizing ICS withdrawal-induced side effects, and explored the underlying mechanisms. The rat COPD model was established using a combination of passive cigarette smoking and intratracheal instillation of lipopolysaccharide (LPS)...
2016: American Journal of Chinese Medicine
Henrik Watz, Kay Tetzlaff, Emiel F M Wouters, Anne Kirsten, Helgo Magnussen, Roberto Rodriguez-Roisin, Claus Vogelmeier, Leonardo M Fabbri, Pascal Chanez, Ronald Dahl, Bernd Disse, Helen Finnigan, Peter M A Calverley
BACKGROUND: Blood eosinophil counts might predict response to inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. We used data from the WISDOM trial to assess whether patients with COPD with higher blood eosinophil counts would be more likely to have exacerbations if ICS treatment was withdrawn. METHODS: WISDOM was a 12-month, randomised, parallel-group trial in which patients received 18 μg tiotropium, 100 μg salmeterol, and 1000 μg fluticasone propionate daily for 6 weeks and were then randomly assigned (1:1) electronically to receive either continued or reduced ICS over 12 weeks...
May 2016: Lancet Respiratory Medicine
A J Ferreira, A Reis, N Marçal, P Pinto, C Bárbara
Current guidelines differ slightly on the recommendations for treatment of Chronic Obstructive Pulmonary Disease (COPD) patients, and although there are some undisputed recommendations, there is still debate regarding the management of COPD. One of the hindrances to deciding which therapeutic approach to choose is late diagnosis or misdiagnosis of COPD. After a proper diagnosis is achieved and severity assessed, the choice between a stepwise or "hit hard" approach has to be made. For GOLD A patients the stepwise approach is recommended, whilst for B, C and D patients this remains debatable...
July 2016: Revista Portuguesa de Pneumologia
Ian A Yang, Janet G Shaw, John R Goddard, Melissa S Clarke, David W Reid
Chronic obstructive pulmonary disease (COPD) is a chronic, inflammatory lung disease characterized by airflow limitation that is not fully reversible. The pathological changes in COPD lead to alveolar destruction (emphysema) and chronic airway inflammation, resulting in airflow obstruction and recurrent exacerbations. Inhaled corticosteroids (ICS) are anti-inflammatory agents that are widely used, especially in combination with long-acting beta-agonists, in patients with COPD. Here, we will summarize the benefits and risks of ICS use for COPD, and discuss approaches to more personalized medicine when selecting COPD patients to commence (or withdraw) ICS use...
2016: Expert Review of Respiratory Medicine
Sae Ahm Kim, Ji-Hyun Lee, Eun-Kyung Kim, Tae-Hyung Kim, Woo Jin Kim, Jin Hwa Lee, Ho Il Yoon, Seunghee Baek, Jae Seung Lee, Yeon-Mok Oh, Sang-Do Lee
BACKGROUND: The purpose of this study was to document outcomes following withdrawal of a single inhaler (step-down) in chronic obstructive pulmonary disease (COPD) patients on triple therapy (long-acting muscarinic antagonist and a combination of long-acting β2-agonists and inhaled corticosteroid), which a common treatment strategy in clinical practice. METHODS: Through a retrospective observational study, COPD patients receiving triple therapy over 2 years (triple group; n=109) were compared with those who had undergone triple therapy for at least 1 year and subsequently, over 9 months, initiated inhaler withdrawal (step-down group, n=39)...
January 2016: Tuberculosis and Respiratory Diseases
Alan G Kaplan
Current guidelines for the management of chronic obstructive pulmonary disease (COPD) recommend limiting the use of inhaled corticosteroids (ICS) to patients with more severe disease and/or increased exacerbation risk. However, there are discrepancies between guidelines and real-life practice, as ICS are being overprescribed. In light of the increasing concerns about the clinical benefit and long-term risks associated with ICS use, therapy needs to be carefully weighed on a case-by-case basis, including in patients already on ICS...
2015: International Journal of Chronic Obstructive Pulmonary Disease
Ahmar Iqbal, Neil C Barnes, Jean Brooks
BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients with blood eosinophil (EOS) count ≥ 2% benefit from exacerbation reductions with inhaled corticosteroids (ICSs). We conducted post hoc analyses to determine if EOS count ≥ 2% is a marker for greater responsiveness to the bronchodilators umeclidinium (UMEC; long-acting muscarinic antagonist), vilanterol (VI; long-acting β2-agonist) or UMEC/VI combination. METHODS: Effects of once-daily UMEC/VI 62...
October 2015: Clinical Drug Investigation
Mario Cazzola, Paola Rogliani, Maria Gabriella Matera
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...
September 2015: Drugs
Anthony D'Urzo, James F Donohue, Peter Kardos, Marc Miravitlles, David Price
INTRODUCTION: Inhaled corticosteroids (ICS) (in fixed combinations with long-acting β2-agonists [LABAs]) are frequently prescribed for patients with chronic obstructive pulmonary disease (COPD), outside their labeled indications and recommended treatment strategies and guidelines, despite having the potential to cause significant side effects. AREAS COVERED: Although the existence of asthma in patients with asthma-COPD overlap syndrome (ACOS) clearly supports the use of anti-inflammatory treatment (typically an ICS/LABA combination, as ICS monotherapy is usually not indicated for COPD), the current level of ICS/LABA use is not consistent with the prevalence of ACOS in the COPD population...
2015: Expert Opinion on Pharmacotherapy
Subramanian, Ragulan, Apar Jindal, V Viswambhar, Arun Babu V
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a common disease causing significant socioeconomic burden. COPD patients, commonly smokers develop resistance to inhaled steroids attributed to deficiency of histone deacetylase 2 (HDAC2). The study of relationship between systemic inflammation and functional performance demonstrated that increased CRP level is inversely related to six minute walk distance (SMWD) and Forced Expired Volume in one second (FEV1). Theophylline restores HDAC2 activity thereby unlocking steroid resistance and potentiating inhaled corticosteroids (ICS) action culminating in reduced airway inflammation and mortality...
February 2015: Journal of Clinical and Diagnostic Research: JCDR
Lisette I Z Kunz, Dirkje S Postma, Karin Klooster, Thérese S Lapperre, Judith M Vonk, Jacob K Sont, Huib A M Kerstjens, Jiska B Snoeck-Stroband, Pieter S Hiemstra, Peter J Sterk
BACKGROUND: We previously observed that 30 months of inhaled corticosteroid (ICS) treatment can attenuate FEV1 decline in COPD, but it is unclear whether withdrawal induces a relapse. We hypothesized that FEV1 decline, airway hyperresponsiveness (AHR), and quality of life (QOL) deteriorate after ICS cessation even after prolonged use. METHODS: One hundred fourteen patients with moderate to severe COPD finished randomized 6-month or 30-month treatment with fluticasone (500 μg bid), 30-month treatment with fluticasone and salmeterol (500/50 μg bid), or placebo (first part of the Groningen and Leiden Universities Corticosteroids in Obstructive Lung Disease [GLUCOLD] study [GL1])...
August 2015: Chest
Bernardino Alcázar Navarrete, Ciro Casanova, Marc Miravitlles, Pilar de Lucas, Juan Antonio Riesco, José Miguel Rodríguez González-Moro
INTRODUCTION: Indications for inhaled corticosteroids (IC) in combination with long-acting bronchodilators (LABD) are well defined in clinical practice guidelines. However, there are some doubts about their efficacy and safety. The aim of this document is to establish an expert consensus to clarify these issues. METHOD: A coordinator group was formed, which systematically reviewed the scientific evidence with the aim of identifying areas of uncertainty about the efficacy of ICs, the adverse effects associated with their use and criteria for withdrawal...
April 2015: Archivos de Bronconeumología
Reza Karbasi-Afshar, Jafar Aslani, Mostafa Ghanei
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major health dilemma and cause of morbidity and mortality in either industrialized or developing countries and inhaled corticosteroids are widely used worldwide in these patients. In this systematic review, we aimed to analyze the effectiveness of these gents compared to placebo. METHODS: Pubmed and Google Scholar literature search has been done to find randomized placebo-controlled trials investigating effectiveness of inhaled steroids in COPD patients...
2014: Caspian Journal of Internal Medicine
Andrea Rossi, Massimo Guerriero, Antonio Corrado
BACKGROUND: It has been suggested that withdrawal of inhaled corticosteroids (ICS) in COPD patients on maintenance treatment results in deterioration of symptoms, lung function and exacerbations. The aim of this real-life, prospective, multicentric study was to investigate whether withdrawal of ICS in COPD patients at low risk of exacerbation is linked to a deterioration in lung function and symptoms and to a higher frequency of exacerbations. METHODS: 914 COPD patients, on maintenance therapy with bronchodilators and ICS, FEV1>50% predicted, and <2 exacerbations/year were recruited...
2014: Respiratory Research
Helgo Magnussen, Henrik Watz, Anne Kirsten, Marc Decramer, Ronald Dahl, Peter M A Calverley, Lesley Towse, Helen Finnigan, Kay Tetzlaff, Bernd Disse
Long-acting bronchodilators in combination with inhaled corticosteroids (ICS) are recommended to decrease the risk of recurrent exacerbations in patients with Global initiative for chronic Obstructive Lung Disease (GOLD) stage 3-4 chronic obstructive pulmonary disease (COPD). There is increasing concern about the clinical benefit and long-term safety of ICS use in COPD patients. The WISDOM (Withdrawal of Inhaled Steroids During Optimised bronchodilator Management) study (NCT00975195) aims to evaluate the need for ICS use via stepwise withdrawal of ICS in COPD patients (GOLD 3-4 with a history of at least one exacerbation during the 12-month period prior to screening) receiving dual bronchodilation...
April 2014: Respiratory Medicine
Kayleigh M Kew, Chris Mavergames, Julia A E Walters
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a respiratory disease that causes progressive symptoms of breathlessness, cough and mucus build-up. It is the fourth or fifth most common cause of death worldwide and is associated with significant healthcare costs.Inhaled long-acting beta2-agonists (LABAs) are widely prescribed to manage the symptoms of COPD when short-acting agents alone are no longer sufficient. Twice-daily treatment with an inhaled LABA is aimed at relieving symptoms, improving exercise tolerance and quality of life, slowing decline and even improving lung function and preventing and treating exacerbations...
2013: Cochrane Database of Systematic Reviews
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