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Withdrawal of inhaled corticosteroids in COPD patients: rationale and algorithms

Authors Avdeev S, Aisanov Z, Arkhipov V, Belevskiy A, Leshchenko I, Ovcharenko S, Shmelev E, Miravitlles M

Received 6 March 2019

Accepted for publication 17 May 2019

Published 10 June 2019 Volume 2019:14 Pages 1267—1280


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Sergey Avdeev,1,2 Zaurbek Aisanov,3 Vladimir Arkhipov,4 Andrey Belevskiy,3 Igor Leshchenko,5 Svetlana Ovcharenko,6 Evgeny Shmelev,7 Marc Miravitlles8

1Department of Pulmonology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation; 2Clinical Department, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia, Moscow, Russian Federation; 3Department of Pulmonology, N.I. Pirogov Russian State National Research Medical University, Moscow, Russian Federation; 4Department of Clinical Pharmacology and Therapy, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation; 5Department of Phthisiology, Pulmonology and Thoracic Surgery, Ural State Medical University, Ekaterinburg, Russian Federation; 6Department of Internal Diseases No.1, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation; 7Department of Differential Diagnostics, Federal Central Research Institute of Tuberculosis, Moscow, Russian Federation; 8Pneumology Department, University Hospital Vall d’Hebron/Vall d’Hebron Research Institute (VHIR), Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain

Abstract: Observational studies indicate that overutilization of inhaled corticosteroids (ICS) is common in patients with chronic obstructive pulmonary disease (COPD). Overprescription and the high risk of serious ICS-related adverse events make withdrawal of this treatment necessary in patients for whom the treatment-related risks outweigh the expected benefits. Elaboration of an optimal, universal, user-friendly algorithm for withdrawal of ICS therapy has been identified as an important clinical need. This article reviews the available evidence on the efficacy, risks, and indications of ICS in COPD, as well as the benefits of ICS treatment withdrawal in patients for whom its use is not recommended by current guidelines. After discussing proposed approaches to ICS withdrawal published by professional associations and individual authors, we present a new algorithm developed by consensus of an international group of experts in the field of COPD. This relatively simple algorithm is based on consideration and integrated assessment of the most relevant factors (markers) influencing decision-making, such a history of exacerbations, peripheral blood eosinophil count, presence of infection, and risk of community-acquired pneumonia.

Keywords: COPD, exacerbation, inhaled corticosteroid, patient follow-up, guideline adherence, treatment algorithm

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