Extract
The recently published European Respiratory Society guideline on withdrawal of inhaled corticosteroids (ICS) in COPD makes a “conditional recommendation for the withdrawal of ICS in patients with COPD without a history of frequent exacerbations” [1]. The authors appropriately specify that a “conditional recommendation” indicates that there is “uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention” [1]. In order to inform patients correctly, however, physicians must have a clear idea of what to recommend in different individual circumstances. It is therefore important to know how to exclude that the absence of exacerbations in a given COPD patient treated with ICS (on top of one or two bronchodilators, as recommended by the Global Initiative for Chronic Obstructive Lung Disease [2]) may not be due, precisely, to ICS treatment itself [3]. If this was the case, withdrawal of ICS in this patient may not be a wise and safe decision. I would be very interested in knowing the view of the panel on this specific scenario. Thanks very much and congratulations for the work done.
Abstract
Withdrawal of inhaled steroid treatment in COPD patients is challenging. The history of the patient needs to be carefully assessed to exclude that they are not being effective and/or safe; and a stepwise approach with careful monitoring seems advisable. https://bit.ly/2y3Tt2k
Footnotes
Conflict of interest: A. Agusti reports grants and personal fees for lectures and advisory board work from GSK, Menarini, Chiesi and AZ, personal fees for lectures from Zambon, outside the submitted work.
- Received May 9, 2020.
- Accepted May 10, 2020.
- Copyright ©ERS 2020