Use of ICS in COPD: From Blockbuster Medicine to Precision Medicine

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality worldwide, whose burden is expected to increase in the next decades, because of numerous risk factors, including the aging of the population. COPD is both preventable and treatable by an effective management including risk factor reduction, prevention, assessment, and treatment of acute exacerbations and co-morbidities. The available agents approved for COPD treatment are long-acting or ultra-long-acting β2-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) bronchodilators, as well as inhaled corticosteroids (ICS) in combination with LABAs. ICS use has been restricted only to selected COPD patients by the most recent documents, mainly based on the risk of exacerbations. However, several observational studies showed a high rate of prescription of ICS in COPD, irrespective of clinical recommendations, questioning the efficacy of these compounds in unselected patients with COPD and leading to possible increase risk of side effects related to ICS use. After examining the low levels of adherence in primary care and in the clinical settings to national and international recommendations for the treatment of COPD in different countries, the most common drivers of the prevailing use of ICS are critically reviewed here by examining their pros and cons, aimed at identifying evidence-based drivers for a proper selection of patients who may benefit from the proper use of ICS.

KEYWORDS:

• COPD
• inhaled corticosteroids
• prescribing
• drivers

Declaration of interest

MC reports grants from GlaxoSmithKline and Chiesi, and personal fees from Chiesi, AstraZeneca, Boehringer Ingelheim, Novartis, Menarini, Mundipharma, Almirall, and Zambon.

AGC has received payments for board membership, income for lectures, or support for research in respiratory disease from the following organizations: AstraZeneca SpA, Boehringer Ingelheim Italia SpA, GlaxoSmithKline SpA, Grifols Italia SpA., Meda Pharma, Novartis Farma SpA., Stallergenes Italia Srl, CSL Behring SpA, A. Menarini Industrie Farmaceutiche Riunite Srl.

PS participated as a lecturer, speaker, and advisor in scientific meetings and courses under the sponsorship of AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, Malesci, Guidotti, Mundipharma, Novartis, and Zambon.

FDM has received honoraria for lectures at national and international meetings from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Dompe, Guidotti/Malesci, GlaxoSmithKline, Menarini, Novartis, and Zambon. He has served as a consultant for AstraZeneca, Chiesi Farmaceutici, Novartis, and Zambon. He has received financial support for research from Novartis.

FB participated as a lecturer, speaker, and advisor in scientific meetings and courses under the sponsorship of AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, Malesci, Guidotti, Lallemand, Mundipharma, Novartis, Zambon, and Dompè.

PR participated as a lecturer, speaker, and advisor in scientific meetings and courses under the sponsorship of Almirall, AstraZeneca, Biofutura, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini Group, Mundipharma, and Novartis. Her department was funded by Almirall, Boehringer Ingelheim, Novartis, and Zambon.

LC has participated as an advisor in scientific meetings under the sponsorship of Boehringer Ingelheim and Novartis, received non-financial support by AstraZeneca, received a research grant partially funded by Boehringer Ingelheim, Novartis, and Almirall, and is or has been a consultant to Edmond Pharma, Zambon and Verona Pharma. His department was funded by Almirall, Boehringer Ingelheim, Novartis, and Zambon.

NS received honoraria for lectures at scientific meetings from Astra-Zeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Guidotti/Malesci, Menarini, and Novartis. He has served as a consultant for AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Novartis, and Zambon. He has received financial support for research from Astra Zeneca, Chiesi Farmaceutici, Guidotti/Malesci, and Novartis.

Acknowledgments

Editorial assistance for the manuscript was provided by Dr. Luisa Granziero, on behalf of Health Publishing & Services srl and supported by an unrestricted grant from Boehringer Ingelheim. Dr. Granziero declares there are no potential conflicts of interest relating to her assistance.