Affiliation:
1. Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the major causes of disability and death. Maintenance use of inhaled bronchodilator(s) is the cornerstone of COPD pharmacological therapy, but inhaled corticosteroids (ICSs) are also commonly used. This narrative paper reviews the role of ICSs as maintenance treatment in combination with bronchodilators, usually in a single inhaler, in stable COPD subjects. The guidelines strongly recommend the addition of an ICS in COPD subjects with a history of concomitant asthma or as a step-up on the top of dual bronchodilators in the presence of hospitalization for exacerbation or at least two moderate exacerbations per year plus high blood eosinophil counts (≥300/mcl). This indication would only involve some COPD subjects. In contrast, in real life, triple inhaled therapy is largely used in COPD, independently of symptoms and in the presence of exacerbations. We will discuss the results of recent randomized controlled trials that found reduced all-cause mortality with triple inhaled therapy compared with dual inhaled long-acting bronchodilator therapy. ICS use is frequently associated with common local adverse events, such as dysphonia, oral candidiasis, and increased risk of pneumonia. Other side effects, such as systemic toxicity and unfavorable changes in the lung microbiome, are suspected mainly at higher doses of ICS in elderly COPD subjects with comorbidities, even if not fully demonstrated. We conclude that, contrary to real life, the use of ICS should be carefully evaluated in stable COPD patients.
Reference99 articles.
1. Global Initiative for Chronic Obstructive Lung Disease (2023, July 30). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Strategy for Prevention, Diagnosis and Management of COPD: 2023 Report. Available online: https://goldcopd.org/2023-gold-report-2/.
2. Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease;Yang;Cochrane Database Syst. Rev.,2023
3. Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus inhaled corticosteroids alone for chronic obstructive pulmonary disease;Nannini;Cochrane Database Syst. Rev.,2013
4. Indacaterol-Glycopyrronium versus Salmeterol-Fluticasone for COPD;Wedzicha;N. Engl. J. Med.,2016
5. INTREPID: Single- versus multiple-inhaler triple therapy for COPD in usual clinical practice;Halpin;ERJ Open Res.,2021
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