. 2023 Jul 24;33:27. doi: 10.1038/s41533-023-00347-6

Table 1.

Possible factors contributing to ICS overuse in patients with COPD.

Reason
• Delayed/late introduction of LAMA to market, e.g., vs. LABA/ICS¹¹⁸ • Overstated importance of ICS-responsive exacerbations in COPD^21,28 • Perceived similarity of asthma and COPD, leading to assumption that as ICS are effective in asthma, they will also be effective in COPD^25,119 • Co-existence of asthma and COPD (either real or due to diagnostic confusion) leading to prescription of ICS^{31,32,118,120} • Exaggerated perception of LABA/ICS benefits in COPD, including hope that the ICS component can reduce the impact of symptoms^32,120 • Lack of confidence in bronchodilators to prevent exacerbations, despite available evidence to the contrary³¹ • Difficulty for physicians in recognising the benefits of long-acting bronchodilators, which may be subtle but meaningful in the long term¹²⁰ • Poor familiarity of prescribing physicians with GOLD recommendations and treatment guidelines for appropriate ICS use^31,120 • Strong influence of physicians’ personal prescribing preferences³¹ • Downplaying the impact of ICS adverse events, e.g., based on the reduced side-effect profile associated with low–moderate doses used in asthma³²
• Randomised controlled trials of triple therapy claiming major benefits in terms of exacerbation and survival vs. dual therapy^54,56

Reason

• Delayed/late introduction of LAMA to market, e.g., vs. LABA/ICS¹¹⁸

• Overstated importance of ICS-responsive exacerbations in COPD^21,28

• Perceived similarity of asthma and COPD, leading to assumption that as ICS are effective in asthma, they will also be effective in COPD^25,119

• Co-existence of asthma and COPD (either real or due to diagnostic confusion) leading to prescription of ICS^{31,32,118,120}

• Exaggerated perception of LABA/ICS benefits in COPD, including hope that the ICS component can reduce the impact of symptoms^32,120

• Lack of confidence in bronchodilators to prevent exacerbations, despite available evidence to the contrary³¹

• Difficulty for physicians in recognising the benefits of long-acting bronchodilators, which may be subtle but meaningful in the long term¹²⁰

• Poor familiarity of prescribing physicians with GOLD recommendations and treatment guidelines for appropriate ICS use^31,120

• Strong influence of physicians’ personal prescribing preferences³¹

• Downplaying the impact of ICS adverse events, e.g., based on the reduced side-effect profile associated with low–moderate doses used in asthma³²

• Randomised controlled trials of triple therapy claiming major benefits in terms of exacerbation and survival vs. dual therapy^54,56

COPD chronic obstructive pulmonary disease, GOLD Global Initiative for Chronic Obstructive Lung Disease, ICS inhaled corticosteroids, LABA long-acting β₂-agonist, LAMA long-acting muscarinic antagonist.