CHEST Guidelines--strong-COUNTERPOINT---strong--Should-an-Attempt-B

-strong-COUNTERPOINT---strong--Should-an-Attempt-B

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The article presents a debate on the use of inhaled corticosteroids (ICS) in the treatment of Chronic Obstructive Pulmonary Disease (COPD). It challenges the traditional view of ICS as a cornerstone therapy for COPD, suggesting it may play a more limited role. The document suggests that ICS should not be universally applied to all COPD patients but should be tailored based on individual patient characteristics, following the principles of precision medicine.<br /><br />A significant portion of the discussion focuses on the efficacy of ICS in reducing exacerbations, particularly in COPD patients with a history of previous flare-ups and higher blood eosinophil counts. Retrospective studies highlighted that ICS therapy benefits are more pronounced in patients with elevated eosinophil levels, indicating eosinophilic airway inflammation as a treatable trait.<br /><br />Furthermore, the document references several studies showing that a combination of long-acting β2-agonist (LABA) and long-acting muscarinic antagonist (LAMA) offers benefits over ICS/LABA, with fewer risks associated with pneumonia. Thus, the current recommendation from GOLD (Global Initiative for Chronic Obstructive Lung Disease) highlights LABA/LAMA as the primary treatment strategy, reserving ICS for patients likely to benefit from them.<br /><br />The WISDOM trial is cited as key evidence showing that in stable COPD patients, ICS can be safely withdrawn if LABA/LAMA therapy is optimized, especially if blood eosinophil counts are low. Overall, the text argues for a biomarker-led approach, using blood eosinophil counts to tailor ICS use, promoting more individualized COPD management strategies, and moving away from a one-size-fits-all method.

Keywords

inhaled corticosteroids

COPD treatment

precision medicine

eosinophil counts

ICS efficacy

LABA/LAMA therapy

biomarker-led approach

WISDOM trial

pneumonia risk

individualized management