In a case-control study, discontinuing inhaled corticosteroids (ICS) in patients with COPD lowered relative risk for pneumonia, according to an article reviewed by the New England Journal of Medicine’s “Journal Watch.”
COPD guidelines recommend adding ICS when patients continue to have exacerbations while taking long-acting bronchodilators. However, ICS use in COPD patients is associated with excess risk for pneumonia and, in some studies, patients who discontinue their ICS exhibit little or no deterioration.
“As many as 85% of COPD patients are treated with ICS, which suggests that these drugs are overused in patients who probably could be managed with long-acting bronchodilators alone,” wrote David J Amrol, MD, contributing editor for NEJM’s Journal Watch. “The benefit of ICS is greatest among patients with COPD/asthma overlap syndrome. Other patients should only be started on ICS if exacerbations continue despite adequate long-acting bronchodilator therapy; once patients are stable, we should consider discontinuing ICS.”
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