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Perspectives

Inhaled corticosteroids in COPD: when are they needed, when not needed and when harmful?

PETER A. FRITH, IAN A. YANG, Kerry Hancock

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© ROBERT KNESCHKE/STOCK.ADOBE.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© ROBERT KNESCHKE/STOCK.ADOBE.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY

Abstract

Inhaled corticosteroids (ICS) have revolutionised asthma control but have a lesser role in patients with chronic obstructive pulmonary disease (COPD) and no asthma. ICS increase risk of pneumonia and other risks in patients with COPD, and long-acting bronchodilators are just as effective in many. Nevertheless, some subgroups may benefit from ICS.

Key Points

  • Inhaled corticosteroids (ICS) have revolutionised asthma control, but their use in patients with chronic obstructive pulmonary disease (COPD) is not as definitive.
  • Long-acting bronchodilators help control symptoms and reduce the risk of exacerbations for most patients with COPD.
  • Adding ICS to dual long-acting bronchodilators reduces exacerbations in patients with a history of recurrent exacerbations or coexisting asthma, especially if blood eosinophil counts are high (more than 0.35 x 109 cells/L).
  • However, use of ICS by patients with COPD increases the risk of pneumonia and some metabolic consequences.
  • ICS should not be used in patients with mild-to-moderate COPD; if already prescribed in these patients they can be judiciously withdrawn.

Figures

© ROBERT KNESCHKE/STOCK.ADOBE.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© ROBERT KNESCHKE/STOCK.ADOBE.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY