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Corticosteroids withdrawal COPD

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https://www.readbyqxmd.com/read/28745524/should-patients-switched-from-d-to-b-in-the-gold-2017-classification-be-discontinued-from-inhaled-corticosteroids
#1
Matevz Harlander, Miriam Barrecheguren, Matjaz Turel, Marc Miravitlles
Inhaled corticosteroids (ICSs) are the cornerstone of the treatment of asthma, but their role in COPD is limited. Several guidelines recommend their use in patients with severe airflow limitation, frequent exacerbations and asthma-COPD overlap (ACO), while the previous GOLD document recommended ICS for patients with high risk of exacerbations and a high level of symptoms (group D). Following the changes in the GOLD document 2017 update, in which impaired lung function is no longer considered as a determinant of exacerbation risk, a high number of COPD patients can now be labeled as group B (low risk of exacerbations and high level of symptoms) instead of D, and hence, no longer fulfill the indication for ICS...
July 26, 2017: COPD
https://www.readbyqxmd.com/read/28663790/recent-advances-in-the-management-of-chronic-obstructive-pulmonary-disease
#2
REVIEW
Sharon R Rosenberg, Ravi Kalhan
Novel pharmacotherapies introduce additional options to providers and patients in how to best treat chronic obstructive pulmonary disease (COPD). Emerging data question the role of inhaled corticosteroids in COPD treatment, particularly as combination dual bronchodilator pharmacotherapies demonstrate robust results. For those maximized on pharmacotherapy with continued dyspnea or exacerbations or both, emerging bronchoscopic procedures may offer additional therapy in select patients. This review focuses on data supporting the use of novel ultra bronchodilators, particularly in combination, and on the role for inhaled corticosteroid withdrawal and new bronchoscopic procedures...
2017: F1000Research
https://www.readbyqxmd.com/read/28606478/withdrawal-of-inhaled-corticosteroids-in-copd-a-meta-analysis
#3
Luigino Calzetta, Maria Gabriella Matera, Fulvio Braido, Marco Contoli, Angelo Corsico, Fabiano Di Marco, Pierachille Santus, Nicola Scichilone, Mario Cazzola, Paola Rogliani
BACKGROUND: Conflicting findings exist on the benefit of withdrawal of inhaled corticosteroid (ICS) in chronic obstructive pulmonary disease (COPD). We performed a quantitative synthesis in order to assess real impact of ICS discontinuation in COPD patients. METHODS: We carried out a meta-analysis via random-effects model on the available clinical evidence to evaluate the effect of ICS discontinuation in COPD. Randomized clinical trials and observational real-life studies investigating the effects of ICS withdrawal on the risk of COPD exacerbation, lung function (forced expiratory volume in 1 s [FEV1]) and quality of life (St...
August 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28506728/-the-effects-of-inhaled-steroids-withdrawal-in-copd
#4
G Jebrak, I Honore, P Serrier, J Dumoulin, P Terrioux, F Soyez, C Maurer, G Mangiapan, M Febvre, L-J Couderc, J-M Braun, T Chinet
The key pathophysiological feature of chronic obstructive pulmonary disease (COPD) is an abnormal inflammatory bronchial reaction after inhalation of toxic substances. The priority is the avoidance of such toxic inhalations, but the use of anti-inflammatory drugs also seems appropriate, especially corticosteroids that are the sole anti-inflammatory drug available for this purpose in France. The risks associated with the prolonged use of these parenteral drugs are well known. Inhalation is therefore the optimal route, but inhaled drugs may also lead to adverse consequences...
May 12, 2017: Revue des Maladies Respiratoires
https://www.readbyqxmd.com/read/28360514/laba-lama-combinations-versus-lama-monotherapy-or-laba-ics-in-copd-a-systematic-review-and-meta-analysis
#5
REVIEW
Gustavo J Rodrigo, David Price, Antonio Anzueto, Dave Singh, Pablo Altman, Giovanni Bader, Francesco Patalano, Robert Fogel, Konstantinos Kostikas
BACKGROUND: Randomized controlled trials (RCTs) indicate that long-acting bronchodilator combinations, such as β2-agonist (LABA)/muscarinic antagonist (LAMA), have favorable efficacy compared with commonly used COPD treatments. The objective of this analysis was to compare the efficacy and safety of LABA/LAMA with LAMA or LABA/inhaled corticosteroid (ICS) in adults with stable moderate-to-very-severe COPD. METHODS: This systematic review and meta-analysis (PubMed/MEDLINE, Embase, Cochrane Library and clinical trial/manufacturer databases) included RCTs comparing ≥12 weeks' LABA/LAMA treatment with LAMA and/or LABA/ICS (approved doses only)...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28203072/-real-life-inhaled-corticosteroid-withdrawal-in-copd-a-subgroup-analysis-of-daccord
#6
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
https://www.readbyqxmd.com/read/28049170/airway-inflammation-in-copd-after-long-term-withdrawal-of-inhaled-corticosteroids
#7
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
https://www.readbyqxmd.com/read/27684954/appropriate-use-of-inhaled-corticosteroids-in-copd-the-candidates-for-safe-withdrawal
#8
REVIEW
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
https://www.readbyqxmd.com/read/27578972/daily-home-based-spirometry-during-withdrawal-of-inhaled-corticosteroid-in-severe-to-very-severe-chronic-obstructive-pulmonary-disease
#9
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/27430907/pinellia-ternata-attenuates-mucus-secretion-and-airway-inflammation-after-inhaled-corticosteroid-withdrawal-in-copd-rats
#10
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
https://www.readbyqxmd.com/read/27066739/blood-eosinophil-count-and-exacerbations-in-severe-chronic-obstructive-pulmonary-disease-after-withdrawal-of-inhaled-corticosteroids-a-post-hoc-analysis-of-the-wisdom-trial
#11
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
https://www.readbyqxmd.com/read/26935750/copd-a-stepwise-or-a-hit-hard-approach
#12
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
https://www.readbyqxmd.com/read/26855301/use-of-inhaled-corticosteroids-in-copd-improving-efficacy
#13
REVIEW
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
https://www.readbyqxmd.com/read/26770231/outcome-of-inhaler-withdrawal-in-patients-receiving-triple-therapy-for-copd
#14
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
https://www.readbyqxmd.com/read/26648711/applying-the-wisdom-of-stepping-down-inhaled-corticosteroids-in-patients-with-copd-a-proposed-algorithm-for-clinical-practice
#15
REVIEW
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
https://www.readbyqxmd.com/read/26329916/is-blood-eosinophil-count-a-predictor-of-response-to-bronchodilators-in-chronic-obstructive-pulmonary-disease-results-from-post-hoc-subgroup-analyses
#16
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/26316169/escalation-and-de-escalation-of-therapy-in-copd-myths-realities-and-perspectives
#17
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
https://www.readbyqxmd.com/read/26194213/a-re-evaluation-of-the-role-of-inhaled-corticosteroids-in-the-management-of-patients-with-chronic-obstructive-pulmonary-disease
#18
REVIEW
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
https://www.readbyqxmd.com/read/25859479/the-study-of-efficacy-tolerability-and-safety-of-theophylline-given-along-with-formoterol-plus-budesonide-in-copd
#19
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
https://www.readbyqxmd.com/read/25836351/relapse-in-fev1-decline-after-steroid-withdrawal-in-copd
#20
RANDOMIZED CONTROLLED TRIAL
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
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