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
To the Editor:
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.
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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