RT Journal Article
SR Electronic
T1 Withdrawal of inhaled corticosteroids in COPD: a European Respiratory Society guideline
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2000351
DO 10.1183/13993003.00351-2020
VO 55
IS 6
A1 James D. Chalmers
A1 Irena F. Laska
A1 Frits M.E. Franssen
A1 Wim Janssens
A1 Ian Pavord
A1 David Rigau
A1 Melissa J. McDonnell
A1 Nicolas Roche
A1 Don D. Sin
A1 Daiana Stolz
A1 Samy Suissa
A1 Jadwiga Wedzicha
A1 Marc Miravitlles
YR 2020
UL http://erj.ersjournals.com/content/55/6/2000351.abstract
AB Inhaled corticosteroids (ICS) combined with bronchodilators can reduce the frequency of exacerbations in some patients with chronic obstructive pulmonary disease (COPD). There is evidence, however, that ICS are frequently used in patients where their benefit has not been established. Therefore, there is a need for a personalised approach to the use of ICS in COPD and to consider withdrawal of ICS in patients without a clear indication. This document reports European Respiratory Society recommendations regarding ICS withdrawal in patients with COPD.Comprehensive evidence synthesis was performed to summarise all available evidence relevant to the question: should ICS be withdrawn in patients with COPD? The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence synthesis was discussed and recommendations formulated by a committee with expertise in COPD and guideline methodology.After considering the balance of desirable and undesirable consequences, quality of evidence, and feasibility and acceptability of interventions, the guideline panel made: 1) conditional recommendation for the withdrawal of ICS in patients with COPD without a history of frequent exacerbations, 2) strong recommendation not to withdraw ICS in patients with blood eosinophil counts ≥300 eosinophils·µL−1 and 3) strong recommendation to treat with one or two long-acting bronchodilators if ICS are withdrawn.A conditional recommendation indicates that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that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.This ERS short guideline summarises the evidence and provides recommendations for ICS withdrawal in patients with COPD https://bit.ly/33R3M5w