New ERS guideline on withdrawal of inhaled corticosteroids in COPD
6 May, 2020
A new European Respiratory Society (ERS) guideline has been published by the European Respiratory Journal that focuses on withdrawal of inhaled corticosteroids (ICS) in the treatment of chronic obstructive pulmonary disease (COPD).
The document was developed in response to recent publications focused on ICS withdrawal as a potential therapeutic option for COPD using a personalised approach to treatment, including meta-analyses and other recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy.
The guideline task force included clinicians, researchers and patient advocates with COPD expertise. A systematic literature review and application of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology were used to evaluate current evidence and answer the key question: “Should ICS be withdrawn in patients with COPD?”
The task force considered desirable and undesirable effects of ICS withdrawal and the quality of evidence, feasibility and acceptability of interventions, to agree on the following:
- A conditional recommendation for the withdrawal of ICS in patients with COPD without a
history of frequent exacerbations.
- A strong recommendation not to withdraw ICS in patients with blood eosinophil counts more than or equal to 300 eosinophils per microlitre.
- A strong recommendation to treat with one or two long-acting bronchodilators if ICS are withdrawn.
Conditional recommendations reflect the uncertainties on the balance of desirable and undesirable effects due to the intervention, and that well-informed patients may choose to have or not have the specific intervention.