Inhaled Corticosteroids Prescribed for COPD Patients with Mild or Moderate Airflow Limitation: Who Warrants a Trial of Withdrawal?

Abstract

COPD patients prescribed inhaled corticosteroids (ICS) outside guidelines should be targeted for ICS withdrawal. Within a primary care population of 209,618 we used a combination of digital search algorithm, individual record review, and clinical review to identify COPD patients suitable for a trial of ICS withdrawal. At most, 39% of COPD patients with mild or moderate airflow limitation prescribed ICS were suitable for withdrawal according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Recurrent exacerbations and reversible airway obstruction were the main reasons for patients’ unsuitability for withdrawal. Identifying COPD patients in whom ICS withdrawal should be considered presents a challenge to primary care clinicians.

Keywords:

• pulmonary disease
• chronic obstructive
• inhaled corticosteroids
• drug withdrawal
• mild airflow limitation
• moderate airflow limitation

Acknowledgments

The authors would like to thank all the participants of the Safe withdrawal of inhaled steroids in mild or moderate COPD (SWAP) trial (ISRCTN65344386) and the staff of the host general practices for their contribution.

Ethics Approval and Consent to Participate

The present study was approved by the London Bridge Research Ethics Committee of the NHS Health Research Authority (REC reference: 16/LO/1696).

Data Sharing Statement

The data upon which this analysis was based are available in anonymised form, upon receipt of an appropriate request.

Author Contributions

The authors meet the criteria for authorship as recommended by the International Committee of Medical Journal Editors. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. PTW provided the original idea for the study. THH collected the data.

Disclosure

Patrick Murphy reports grants, personal fees from ResMed, Philips, Breas, Santhera, Fisher & Paykel, outside the submitted work. Mike Thomas reports personal fees from GSK and Novartis, outside the submitted work. The authors report no other conflicts of interest in this work.