Risk of pneumonia associated with long-term use of inhaled corticosteroids in chronic obstructive pulmonary disease: a critical review and update

ICS are like any other drug: they have benefits and they have risks.6,7 In the right patient, often the patient with frequent exacerbations and severe uncontrolled symptoms, an inhaler regimen, including dual long-acting bronchodilators and an ICS may be the right choice. For the patient with infrequent exacerbations, low symptom burden, and recent pneumonia that caused hospitalization, an inhaler regimen that contains an ICS may bring more risk than benefit. In addition, analysis of recent data, including the WISDOM8 trial, has provided evidence that ICS may be most beneficial in the immediate postexacerbation period. Further, ICS may be safely discontinued in patients with few exacerbations and stable symptoms.9 As with any long-term medication, a nuanced risk-benefit calculation by the prescribing physician and informed discussion with the patient are ultimately the best ways to balance the use of ICS that have benefits in some patients and risks in others.

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Long-term Use of Inhaled Corticosteroids and the Risk of Pneumonia in Chronic Obstructive Pulmonary Disease

Archives of Internal Medicine ◽

10.1001/archinternmed.2008.550 ◽

2009 ◽

Vol 169 (3) ◽

pp. 219 ◽

Cited By ~ 187

Author(s):

Sonal Singh ◽

Aman V. Amin ◽

Yoon K. Loke

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Inhaled Corticosteroids ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

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Differential treatment strategy in patients with different clinical phenotypes of chronic obstructive pulmonary disease

Kazan medical journal ◽

10.17816/kmj1902 ◽

2013 ◽

Vol 94 (5) ◽

pp. 610-614

Author(s):

E A Lapteva

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Treatment Strategy ◽

Inhaled Corticosteroids ◽

Control Treatment ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Clinical Phenotypes ◽

Long Acting

Aim. To optimize the treatment in patients with chronic obstructive pulmonary disease in primary care. Methods. The effectiveness of different strategies of long-term control treatment in 245 patients with chronic obstructive pulmonary disease depending on clinical phenotypes of the disease was evaluated. Three groups of patients were formed: patients from the 1 st group (70 patients, 33 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) were using long-acting anticholinergics, patients from the 2 nd group (110 patients, 52 - with predominant emphysema phenotype, 58 - with predominant bronchitis phenotype) - long-acting anticholinergics and inhaled corticosteroids, and patients from the 3 rd group (65 patients, 28 - with predominant emphysema phenotype, 37 - with predominant bronchitis phenotype) - long-acting anticholinergics together with inhaled corticosteroids and long-acting beta 2-agonists. The respiratory function, diffusing lung capacity and gas exchange parameters were assessed after 12 months of long-term control treatment. Results. The 2nd treatment strategy was more effective in patients with bronchitis phenotype, confirmed by the increase of forced expiratory volume at 1st second (FEV 1) value from 1.12±1.04 to 1.90±1.05 (р 0.05), and partial oxygen pressure (р аО 2) increase from 53.72±6.28 to 69.56±6.83 mmHg, as well as partial carbon dioxide pressure (р аCО 2) decrease from 55.71±8.34 to 52.34±8.16 mmHg. No significant changes in patients with emphysema phenotype were observed. The treatment strategy 3 was the most effective in patients with emphysema phenotype which was demonstrated by the increase of FEV 1 from 1.18±0.03 to 1.47±0.03, р аО 2 from 66.43±3.79 to 78.48±5.78 mmHg (р 0.05), diffusion capacity of carbon monoxide to alveolar volume ratio (DLCO/Va) increase from 35.32±11.34 to 44.12±12.2 (р 0.05) and decrease of р аО 2 from 50.21±3.68 to 43.43±5.47 mmHg. No significant improvement of gas exchange parameters in patients with bronchitis phenotype was registered. The treatment strategy 1 had no significant effect on respiratory function parameters. Conclusion. The differential strategies of long-term control treatment should be used depending on clinical phenotypes to optimize the treatment of chronic obstructive pulmonary disease.

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Con: Inhaled corticosteroids should not be used in patients with chronic obstructive pulmonary disease

Journal of Precision Respiratory Medicine ◽

10.2500/jprm.2019.190007 ◽

2019 ◽

Vol 2 (1) ◽

pp. 41-45

Author(s):

Margaret F. Ragland ◽

Barry J. Make

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Inhaled Corticosteroids ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Substantial Body ◽

Therapy Regimen ◽

Increased Risk ◽

Inhaled Therapy

Background: Inhaled corticosteroids (ICS) are frequently used in the treatment of chronic obstructive pulmonary disease (COPD). However, recent evidence indicates that the routine use of ICS in patients with COPD should be re-examined. Objectives: (1) To review the evidence about the risks of ICS in patients with COPD, and (2) to provide considerations for patients in whom ICS should not be used. Methods: A thorough review of the key literature that evaluates the risks of the use of ICS in patients with COPD. Results: The data that support the use of ICS as part of combination therapy in patients with COPD showed that, in some patients, these ICS can reduce exacerbations, improve lung function, and lessen breathlessness. However, there is a substantial body of evidence that demonstrates the increased risk of pneumonia, cataracts, osteoporosis, adrenal insufficiency, and other complications from the long-term use of ICS. This mounting collection of evidence of adverse events as a result of ICS is a reason to be hesitant about prescribing these medications in patients with COPD. Conclusion: The risks of ICS must be carefully weighed against the benefits when ICS are used as part of a long-term inhaled therapy regimen for patients with COPD. Prescribers should carefully consider the utility of these medications and consider stopping them when no longer indicated so to minimize the risks that patients are exposed to as a result of ICS.

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Triple therapy in chronic obstructive pulmonary disease

Russian Pulmonology ◽

10.18093/0869-0189-2019-29-2-199-206 ◽

2019 ◽

Vol 29 (2) ◽

pp. 199-206

Author(s):

Sergey N. Avdeev ◽

Natal’ya V. Trushenko

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Triple Therapy ◽

Pulmonary Disease ◽

Inhaled Corticosteroids ◽

Chronic Obstructive ◽

Published Data ◽

Triple Combination ◽

Obstructive Pulmonary Disease ◽

Consensus Statements

Recently, therapeutic options for treatment of chronic obstructive pulmonary disease (COPD) has been significantly extended, mainly due to new double and triple drug combinations in a single inhaler. Double combinations for treatment of COPD include long-term acting beta-2-agonists (LABA)/long-term acting muscarinic antagonists (LAMA) and LABA/inhaled corticosteroids (ICS); a triple combination is a combination of LABA, LAMA and ICS in a single inhaler. A review of consensus statements, national guidelines and recently published data about use of triple therapy in COPD, efficacy and safety of a triple combination is given in the article.

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