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Pdf Summary

The discussion focuses on whether inhaled corticosteroids (ICS) should be withdrawn in patients with stable GOLD 3 COPD, characterized by a specific range of lung function impairment (30% ≤ FEV1 < 50% predicted). Dr. James D. Chalmers from Dundee argues in favor of withdrawing ICS, suggesting they are often overused and less effective for most COPD patients, particularly those with neutrophilic inflammation, as opposed to eosinophilic inflammation where ICS can be beneficial. <br /><br />ICS, though effective at reducing eosinophilic inflammation, do not impact neutrophilic inflammation, which is common in severe COPD. The combination of ICS with neutrophils and bacteria might increase risks like pneumonia. Recent strategies suggest using ICS only as an add-on treatment following combined bronchodilators for patients with frequent exacerbations (termed GOLD D patients).<br /><br />Moreover, studies have shown ICS might not significantly reduce exacerbations when compared to a more effective LABA/LAMA combination, and there are long-term safety concerns, such as potential adrenal insufficiency risks when switching or withdrawing ICS. Chalmers presents a personalized approach, recommending ICS withdrawal for patients who don't benefit from them, except those with eosinophilic disease or a history of favorable ICS response.<br /><br />Conversely, Dr. Ian D. Pavord and others argue that ICS remain effective in reducing exacerbations in some patients and are reluctant to withdraw ICS universally without considering individual patient benefits and safety risks. Past evidence suggests ICS can reduce moderate or severe exacerbations, and new studies encourage continued analysis.<br /><br />The debate highlights the need for personalized COPD treatment, integrating patient history, inflammation type, exacerbation frequency, and potential risks from medications, aiming for judicious use of interventions tailored to individual patient characteristics.

Keywords

COPD

inhaled corticosteroids

ICS withdrawal

neutrophilic inflammation

eosinophilic inflammation

GOLD 3

bronchodilators

LABA/LAMA combination

pneumonia risk

personalized treatment