Inhaled corticosteroid overuse and deprescribing eligibility in COPD (iCODEC Study): a nationwide cross-sectional...

Inhaled corticosteroid (ICS) overuse is common in chronic obstructive pulmonary disease (COPD) and associated with substantial adverse effects. Deprescribing has emerged as a strategy to optimize therapy, yet large-scale evidence on the prevalence and associated factors of eligibility for ICS deprescribing is limited. This nationwide cross-sectional study analyzed data from the Cough and Wheeze Pharmaceutical Care Clinics database between January 2021 and September 2024. Patients aged ≥40 years with physician-diagnosed COPD receiving long-acting inhaled therapies were included. We examined treatment patterns, estimated ICS use, and assessed eligibility for deprescribing using European Respiratory Society (ERS), American Thoracic Society (ATS), and Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 criteria, applied respectively to any ICS-containing regimens, triple therapy, and ICS/long-acting beta-agonist (LABA) combinations. Factors associated with ICS deprescribing eligibility were identified using multivariable logistic regression, with sensitivity analyses on complete-case data. Of 33,243 patients, 24,886 (74.9%) received ICS-containing regimens, mainly triple therapy and ICS/LABA. Among them, 79.5% met ERS criteria for deprescribing. In the triple therapy subgroup (n = 12,388), 68.9% met ATS criteria, while 74.0% of patients on ICS/LABA combinations (n = 12,340) met GOLD criteria. Eligibility was positively associated with male sex, older age, higher regional economic level, lack of health insurance, and care in secondary hospitals, whereas higher comorbidity burden was negatively associated. Sensitivity analyses yielded consistent results. These findings highlight that ICS overuse is common among COPD patients in China, with most being eligible for deprescribing. Implementing targeted strategies that address the identified associated factors could support deprescribing and enhance treatment optimization.