Abstract
What is this summary about?
Inhaled corticosteroids (ICS) are a type of medication delivered via an inhaler device that are commonly used in the treatment of asthma. ICS can also be used to treat chronic obstructive pulmonary disease (COPD), a progressive respiratory condition in which the lungs become worse over time. However, unlike in asthma, ICS are only effective in a small proportion of people with COPD.
ICS can cause significant side effects in people with COPD, including pneumonia. Because of this, guidelines written by COPD experts recommend that ICS should largely be prescribed to people with COPD whose symptoms flare up frequently and become difficult to manage (episodes known as exacerbations).
Despite this guidance, records collected from routine clinical practice suggest that many healthcare professionals prescribe ICS to people with COPD who do not have frequent exacerbations, putting them at unnecessary risk of side effects.
The over-prescription of ICS in COPD may partly be due to the recent introduction of single-inhaler combination therapies, which combine ICS with other medicines (bronchodilators). This ‘one inhaler for all’ approach is a concerning trend as it goes against global COPD treatment guidelines, which recommend ICS use in only a small proportion of people.
This is a plain language summary of a review article originally published in the journal NPJ Primary Care Respiratory Medicine. In this review, we investigate the benefits and risks of ICS use in COPD. Using data from both randomized controlled trials (RCTs) and observational studies, we explain which people benefit from ICS use, and why health regulatory bodies have concluded that ICS do not help people with COPD to live longer. Lastly, we provide practical guidance for doctors and people with COPD regarding when ICS should be prescribed and when they should be withdrawn.
Video abstract
Keywords: chronic obstructive pulmonary disease COPD, ICS, inhaled corticosteroids, LAMA/LABA, lay summary, long-acting bronchodilators, observational study, plain language summary, randomized controlled trial, real-world evidence, treatment guidelines
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Acknowledgments
The original article discussed in this summary was written by Jennifer K Quint, Amnon Ariel, and Peter J Barnes. All authors of this plain language summary meet the International Committee of Medical Journal Editors (ICMJE) authorship criteria.
Footnotes
Financial disclosure
The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Competing interest disclosure
A Ariel reports personal fees from AstraZeneca, and personal fees and non-financial support from Boehringer Ingelheim, outside the submitted work. PJ Barnes reports research funding from AstraZeneca and Boehringer Ingelheim; consulting fees from AstraZeneca, Boehringer Ingelheim and Teva; and payment or honoraria for lectures, presentations, speaker bureaus or educational events from AstraZeneca, Boehringer Ingelheim, Novartis and Teva. T Maricoto reports advisory board personal fees, speaking fees and consulting fees from AstraZeneca, Bial, GlaxoSmithKline, Teva, Boehringer Ingelheim, Sanofi, Procter & Gamble, Viatris, Biocodex, Novartis, Pfizer and Medinfar. M Román-Rodríguez reports speaking fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Menarini and Bial; consulting fees from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKline; and research grants from AstraZeneca in the last 3 years. A Powell reports personal fees for advisory boards, speaking fees and educational event attendance from Napp, Teva, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, AstraZeneca, Novartis and Chiesi. JK Quint reports personal fees for advisory board participation or speaking fees from GlaxoSmithKline, Boehringer Ingelheim, AstraZeneca and Chiesi. The authors have no other competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript apart from those disclosed.
Writing disclosure
Rose Martin of Meditech Media provided writing support, which was contracted and funded by Boehringer Ingelheim. Boehringer Ingelheim was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations.
Open access
This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/