Stepping down ICS therapy in COPD
Long-acting bronchodilators are first-line treatment for people with chronic obstructive pulmonary disease (COPD). The addition of inhaled corticosteroids (ICS) is recommended for patients with concomitant asthma and COPD, and in COPD patients with severe-to-very-severe airflow limitation and/or frequent exacerbation (two or more per year) not adequately controlled by long-acting bronchodilators, or one or more hospitalisations for exacerbation.
In most industrialised countries, approximately 40% of patients diagnosed with COPD are candidates for ICS (according to criteria set by the Global Initiative for COPD). The fact that prescribing rates can exceed 80% means not only that a lot of patients are being exposed to the risks associated with ICS, but that the cost of their care is unnecessarily high.
Therefore, it is important to know whether and how ICS treatment can be safely withdrawn. The International Primary Care Respiratory Group (IPCRG) has produced a desktop helper, adapted here by the Primary Care Respiratory Society UK (PCRS-UK), entitled ‘Evaluation of appropriateness of inhaled corticosteroid (ICS) therapy in COPD and guidance on ICS withdrawal’.