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Withdrawal of Inhaled Corticosteroids in Patients with COPD – A Prospective Observational Study

Authors Nielsen AO, Hilberg O, Jensen JUS, Kristensen SH, Frølund JC, Langkilde PK, Løkke A

Received 4 December 2020

Accepted for publication 22 February 2021

Published 26 March 2021 Volume 2021:16 Pages 807—815


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 6

Editor who approved publication: Dr Richard Russell

Anne Orholm Nielsen,1 Ole Hilberg,2,3 Jens Ulrik Stæhr Jensen,4 Steffen Helmer Kristensen,5 Jannie Christina Frølund,2 Pernille Kølholt Langkilde,6 Anders Løkke2,3

1Department of Medicine, Zealand University Hospital, Roskilde, Denmark; 2Department of Medicine, Hospital Little Belt, Vejle, Denmark; 3Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 4Department of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Copenhagen, Denmark; 5Department of Pulmonary Medicine, Aalborg University Hospital, Aalborg, Denmark; 6Department of Medicine, Hospital Little Belt, Kolding, Denmark

Correspondence: Anne Orholm Nielsen
Department of Medicine, Zealand University Hospital, Roskilde, Denmark
Email [email protected]

Background: Inhaled corticosteroids (ICS) are widely used in the treatment of chronic obstructive pulmonary disease (COPD), but recent studies have raised doubts whether all COPD patients will benefit from ICS. This study evaluates in a real-life setting the effects of ICS withdrawal in patients with COPD.
Methods: The study was a prospective intervention study following patients with COPD for 6 months after abrupt withdrawal of ICS. FEV1 (L), blood eosinophilic count (x10E9/L) and number of exacerbations were measured at baseline, 1, 3 and 6 months after ICS withdrawal.
Results: Ninety-six patients (56 females (57.4%), mean age 70 years (51– 94 years)) with COPD were included in the study. Eleven patients were excluded during the study period (7 patients died, 4 patients withdrew their consent during the study period). During the 6 months, 51 patients (60%) had resumed treatment with ICS, of whom 34 patients (68%) experienced an exacerbation during follow-up. No significant decline in FEV1 was seen in this group between baseline and after 6 months (ΔFEV1 0.07 L, p = 0.09). In the remaining 34 patients (40%) without ICS after 6 months of follow-up, 15 patients (44.1%) experienced an exacerbation. No significant decline was seen in FEV1 at baseline and after 6 months (ΔFEV1 0.04 L, p = 0.28). There were no statistically significant differences between the two groups in age (70.5 vs 69.6 years, p = 0.53), nor between FEV1 at baseline (0.96 L vs 1.00 L, p = 0.63) or eosinophilic count (0.25 x10E9/L vs 0.17 x10E9/L, p = 0.07).
Conclusion: Abrupt withdrawal of ICS was possible in some patients. However, more than half of the patients resumed ICS during follow-up. Based on results from our study we were not able to foresee – from neither history of exacerbations nor eosinophilic count – whom will be able to manage without ICS and who will resume treatment with ICS.

Keywords: COPD, inhaled corticosteroids, withdrawal, real-life setting

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