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The dose of inhaled corticosteroids in patients with COPD: when less is better

Authors Izquierdo JL, Cosio BG

Received 23 May 2018

Accepted for publication 12 September 2018

Published 25 October 2018 Volume 2018:13 Pages 3539—3547

DOI https://doi.org/10.2147/COPD.S175047

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell


José Luis Izquierdo,1 Borja G Cosio2,3

1Department of Pneumology and Medicine, Hospital Universitario, Universidad de Alcalá, Guadalajara, Spain; 2Department of Respiratory Medicine, Hospital Son Espases-IdISBa, Palma de Mallorca, Spain; 3CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain

Background: The use of inhaled corticosteroids (ICS) in combination with bronchodilators in patients with COPD has been shown to decrease the rate of disease exacerbations and to improve the lung function and patients’ quality of life. However, their use has also been associated with an increased risk of pneumonia.
Materials and methods: We have reviewed existing clinical evidence on the risks and benefits of ICS in COPD, including large randomized clinical trials, meta-analyses, and clinical reviews.
Results: A large body of evidence supports the clinical benefits of ICS in patients with COPD in terms of exacerbations, symptoms, lung function, and quality of life. The incidence of adverse events related to ICS, including pneumonia, varies strongly among the studies and seems to be dose dependent, with recent well-designed, large studies on low-dose ICS reporting similar safety profiles in ICS and non-ICS groups.
Conclusion: The benefits of ICS in COPD continue to outweigh the risks, especially when lower ICS doses are employed. Given that the data on ICS withdrawal in COPD are scarce and conflicting, we argue that using reduced doses of ICS could be an optimal strategy to manage patients with COPD.

Keywords: acute exacerbations, anti-inflammatory effects, COPD, asthma-COPD overlap syndrome, inhaled corticosteroids, lower doses of ICS, pneumonia

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