RT Journal Article
SR Electronic
T1 Inhaled corticosteroids in COPD: Friend or foe?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1801219
DO 10.1183/13993003.01219-2018
A1 Alvar Agusti
A1 Leonardo M Fabbri
A1 Dave Singh
A1 Jørgen Vestbo
A1 Bartolome Celli
A1 Frits ME Franssen
A1 Klaus F. Rabe
A1 Alberto Papi
YR 2018
UL http://erj.ersjournals.com/content/early/2018/08/23/13993003.01219-2018.abstract
AB The efficacy, safety and positioning of inhaled corticosteroids (ICS) in the treatment of patients with chronic obstructive pulmonary disease (COPD) is much debated, since it can result in clear clinical benefits in some patients (“friend”) but can be ineffective or even associated with undesired side effects, e.g. pneumonia, in others (“foe”). After critically reviewing the evidence for and against ICS treatment in patients with COPD, we propose that: 1) ICS should not be used as a single, stand-alone therapy in COPD; 2) patients most likely to benefit from the addition of ICS to long-acting bronchodilators include those with history of multiple or severe exacerbations despite appropriate maintenance bronchodilator use, particularly if blood eosinophils are >300 cells·µL−1, and those with a history of and/or concomitant asthma; and 3) the risk of pneumonia in COPD patients using ICS is higher in those with older age, lower body mass index, greater overall fragility, receiving higher ICS doses and those with blood eosinophils <100 cells·µL−1. All these factors must be carefully considered and balanced in any individual COPD patient before adding ICS to her/his maintenance bronchodilator treatment. Further research is needed to clarify some of these issues and firmly establish these recommendations.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Agusti reports grants from GSK, personal fees from Novartis, grants and personal fees from Astra-Zeneca, personal fees from Chiesi, personal fees from Boheringer-Ingelheim, outside the submitted work.Conflict of interest: Dr. Fabbri reports grants, personal fees and non-financial support from.Conflict of interest: Dr. Singh reports grants and personal fees from Almirall, grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingleheim, grants and personal fees from Chiesi, grants and personal fees from GlaxoSmithKline, grants and personal fees from Glenmark, grants and personal fees from Johnson and Johnson, grants and personal fees from Merck, grants and personal fees from NAPP, grants and personal fees from Novartis, grants and personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Teva, grants and personal fees from Therevance, grants and personal fees from Verona, personal fees from Genentech, personal fees from Skeypharma, outside the submitted work.Conflict of interest: Dr. Vestbo reports personal fees from GlaxoSmithKline, personal fees from Chiesi Pharmaceuticals, personal fees from Boehringer-Ingelheim, personal fees from Novartis, personal fees from AstraZeneca, outside the submitted work.Conflict of interest: Dr. Celli reports personal fees and other from Astra Zeneca, personal fees from GlaxoSmithKline, personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Chiesi, personal fees from Menarini, outside the submitted work.Conflict of interest: Dr. Franssen reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Chiesi, personal fees from GlaxoSmithKline, grants and personal fees from Novartis, personal fees from TEVA, outside the submitted work.Conflict of interest: Dr. Rabe reports personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from Sanofi, personal fees from Teva, grants from Ministry of Education and Science, Germany, personal fees from Intermune, personal fees from Chiesi Pharmaceuticals, personal fees from Berlin Chemie, outside the submitted work.Conflict of interest: Dr. Papi reports grants, personal fees, non-financial support and other from Chiesi, grants, personal fees, non-financial support and other from Astrazeneca, grants, personal fees, non-financial support and other from GlaxoSmithKline, grants, personal fees, non-financial support and other from Boehringer Ingelheim, personal fees and non-financial support from Menarini, personal fees and non-financial support from Novartis, personal fees and non-financial support from Zambon, grants, personal fees, non-financial support and other from Mundipharma, grants, personal fees, non-financial support and other from TEVA, grants from Sanofi, outside the submitted work.