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Inhaled corticosteroids in COPD: friend or foe?

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…

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Articles of Interest

Appropriate use of inhaled corticosteroids in COPD: the candidates for safe withdrawal

International guidance on chronic obstructive pulmonary disease (COPD) management recommends the use of inhaled corticosteroids (ICS) in those patients at increased likelihood of exacerbation. In spite of this guidance, ICS are prescribed in a large number of patients who are unlikely to benefit.

Do Inhaled Corticosteroids Reduce All-Cause Mortality in Chronic Obstructive Pulmonary Disease? What is the Latest Evidence?

Triple therapy (ICS/LABA/LAMA) appears to improve survival greater than ICS/LABA suggesting that the use of LAMA in conjunction with ICS/LABA/LAMA confers some further improvement in survival.

Inhaled Corticosteroid Treatment in Chronic Obstructive Pulmonary Disease (COPD): Boon or Bane?

Inhaled corticosteroid (ICS)–based therapy is often used for patients with chronic obstructive pulmonary disease (COPD). However, this approach is under scrutiny because of ICS overuse in patients for whom it is not recommended and because of concerns about adverse events, particularly pneumonia, with long-term ICS use. Evidence suggests ICS may be beneficial in specific patients, namely, those with high blood eosinophil counts...

Inhaled Corticosteroids Are Not Beneficial in Chronic Obstructive Pulmonary Disease

There is now overwhelming evidence that long-term treatment with inhaled corticosteroids provide no significant clinical benefit to patients with COPD. The disease process in COPD appears to be steroid resistant. Yet patients with COPD are often treated with high doses of inhaled corticosteroids for want of any effective therapy in this disease.

Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy?

Inhaled corticosteroids (ICSs) are a mainstay of COPD treatment for patients with a history of exacerbations. Initial studies evaluating their use as monotherapy failed to show an effect on rate of pulmonary function decline in COPD, despite improvements in symptoms and reductions in exacerbations. Subsequently, ICS use in combination with long-acting β2-agonists (LABAs) was shown to provide improved reductions in exacerbations, lung function, and health status. ICS-LABA combination therapy is currently recommended for patients with a history of exacerbations despite treatment with long-acting bronchodilators alone.

Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease

Inhaled corticosteroids (ICSs) should not be prescribed as monotherapy in chronic obstructive pulmonary disease (COPD).

Inhaled Corticosteroids in COPD: Trying to Make a Long Story Short

The use of inhaled corticosteroids (ICSs) in long-term treatment of COPD has been a debated topic for a long time. According to the evidence produced till now, ICSs are presently advocated in combination with long-acting bronchodilators for high-risk symptomatic COPD patients with a history of frequent COPD exacerbations.

Inhaled steroids for stable chronic obstructive pulmonary disease

Patients and clinicians should balance the potential benefits of inhaled steroids in COPD (reduced rate of exacerbations, reduced rate of decline in quality of life and possibly reduced rate of decline in FEV1) against the potential side effects (oropharyngeal candidiasis and hoarseness, and risk of pneumonia).

Is it Time to Readjust the Doses of Inhaled Corticosteroids in COPD?

The old discussion by the end of the last century about the use of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) generated a lot of ink and dialectical confrontations – sometimes heated – between the defenders of the role of ICS in COPD, who based their arguments on the effect on the prevention of exacerbations (and the much discussed p value=0.052 of the TORCH study, – do you remember that?), and the ardent defenders of the FLAME study, which made ICS the enemy to beat, partly supported by clear signs of an increased risk of pneumonia associated with this treatment.

The Use of Inhaled Corticosteroids for Patients with COPD Who Continue to Smoke Cigarettes: An Evaluation of Current Practice

The use of inhaled corticosteroids (ICS) in combination with inhaled bronchodilators for patients with chronic obstructive pulmonary disease (COPD) is a common practice in primary care settings. However, ICS-containing therapies may be less effective in patients with COPD compared with asthma, and in individuals with COPD who continue to smoke cigarettes.