Inhaled corticosteroids for chronic obstructive pulmonary disease

Abstract

Introduction: Current guidelines recommend the use of inhaled long-acting bronchodilators, inhaled corticosteroids (ICSs) and their combinations for maintenance treatment of moderate-to-severe chronic obstructive pulmonary disease (COPD); however, it is questionable whether all COPD patients should be treated, as the long-term use of ICSs is accompanied by side effects.

Areas covered: This article reviews the evidence about the effects of ICSs in the treatment of COPD. It mainly focuses on meta-analyses of published data and pooled analyses of primary data. It also offers an overview of pipeline developments.

Expert opinion: There is now more evidence that there are subsets of patients (mainly, frequent exacerbators with predominant chronic bronchitis and those with overlap between COPD and asthma) with a favorable response to treatment with ICSs (i.e., reduced progression of lung function loss, reduced exacerbation rate and improved health-related quality of life). Therefore, nowadays, the right question is not whether ICSs should not be used at all unless patients have concomitant asthma, but, instead, which COPD patient can benefit from a therapy with ICSs. Unfortunately, however, the number of studies that have investigated the clinical features that might predict corticosteroid response in COPD is still inadequate.

Keywords::

• chronic obstructive pulmonary disease
• emerging inhaled corticosteroids
• guidelines
• inhaled corticosteroids

Declaration of interest

M Cazzola has received honoraria for speaking and consulting and/or financial support for attending meetings from Abbott, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Dey, GlaxoSmithKline, Lallemand, Menarini Farmaceutici, Mundipharma, Novartis, Pfizer, Sanovel, Sigma Tau, Takeda and Valeas. Paola Rogliani has received honoraria for speaking and/or financial support for attending meetings from Almirall, Boehringer Ingelheim, GlaxoSmithKline and Sigma Tau. Lucia Novelli has no financial relationship with a commercial entity with interests in the subject of this manuscript. Maria Gabriella Matera has received honoraria for speaking and consulting and/or financial support for attending meetings from AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Novartis, Pfizer and Takeda.

Notes

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