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Inhaled Corticosteroids in Subjects with Chronic Obstructive Pulmonary Disease: An Old, Unfinished History
Andrea S Melani1, Sara Croce1, Gaia Fabbri1
1Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy.
Biomolecules
|February 24, 2024
Summary
Inhaled corticosteroids (ICSs) are widely used in COPD management, but guidelines suggest cautious use in stable patients. While triple therapy may reduce mortality, potential side effects warrant careful evaluation.
Area of Science:
- Pulmonology
- Respiratory Medicine
- Pharmacotherapy
Background:
- Chronic obstructive pulmonary disease (COPD) significantly contributes to global morbidity and mortality.
- Maintenance bronchodilators are standard COPD therapy, with inhaled corticosteroids (ICSs) often added.
Purpose of the Study:
- To review the role of ICSs in maintenance therapy for stable COPD patients, particularly in combination with bronchodilators.
- To compare guideline recommendations with real-world usage of triple inhaled therapy.
Main Methods:
- Narrative review of existing literature and guidelines.
- Discussion of recent randomized controlled trials on triple inhaled therapy versus dual bronchodilator therapy.
Main Results:
- Guidelines recommend ICSs for specific COPD subgroups (e.g., asthma history, frequent exacerbations with high eosinophils).
- Real-world triple therapy use is widespread, often exceeding guideline indications.
- Triple therapy showed reduced all-cause mortality compared to dual bronchodilator therapy in recent trials.
- ICS use is linked to local adverse events (dysphonia, candidiasis, pneumonia) and potential systemic effects.
Conclusions:
- ICS use in stable COPD requires careful consideration, diverging from common clinical practice.
- The benefits of triple therapy in reducing mortality must be weighed against potential adverse events and specific patient profiles.
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