stepping down inhaled corticosteroids in patients with COPD

[gerald]

The link provides access to the abstract and the full writeup.  

Not sure it applies to everyone. However it looks promising and may provide some support for those that may have problems handling any side effects from corticosteroids.


---------------------------
Applying the wisdom of stepping down inhaled corticosteroids in patients with COPD: a proposed algorithm for clinical practice

Current guidelines for the management of chronic obstructive pulmonary disease (COPD) recommend limiting the use of inhaled corticosteroids (ICS) to patients with more severe disease and/or increased exacerbation risk. However, there are discrepancies between guidelines and real-life practice, as ICS are being overprescribed.

In light of the increasing concerns about the clinical benefit and long-term risks associated with ICS use, therapy needs to be carefully weighed on a case-by-case basis, including in patients already on ICS. Several studies sought out to determine the effects of withdrawing ICS in patients with COPD.

Early studies have deterred clinicians from reducing ICS in patients with COPD as they reported that an abrupt withdrawal of ICS precipitates exacerbations, and results in a deterioration in lung function and symptoms. However, these studies were fraught with numerous methodological limitations.

Recently, two randomized controlled trials and a real-life prospective study revealed that ICS can be safely withdrawn in certain patients. Of these, the WISDOM (Withdrawal of Inhaled Steroids During Optimized Bronchodilator Management) trial was the largest and first to examine stepwise withdrawal of ICS in patients with COPD receiving maintenance therapy of long-acting bronchodilators (ie, tiotropium and salmeterol).

Even with therapy being in line with the current guidelines, the findings of the WISDOM trial indicate that not all patients benefit from including ICS in their treatment regimen. Indeed, only certain COPD phenotypes seem to benefit from ICS therapy, and validated markers that predict ICS response are urgently warranted in clinical practice. Furthermore, we are now better equipped with a larger armamentarium of novel and more effective long-acting β2-agonist/long-acting muscarinic antagonist combinations that can be considered by clinicians to optimize bronchodilation and allow for safer ICS withdrawal. In addition to providing a review of the aforementioned, this perspective article proposes an algorithm for the stepwise withdrawal of ICS in real-life clinical practice.


www.dovepress.com/applying-the-wisdom-of-stepping-down-inhaled-corticosteroids-in-patien-peer-reviewed-fulltext-article-COPD

[izzie]

Very interesting article Gerald........clearly not all medications are a one-size fits all. Sometimes, I wish the medical community would take a closer look at diet, because there are a few food items and herbal tea preparations that clearly help me breathe a lot easier.

Diets like the low-inflammation diet that Dr. Weil promotes on his website and in his books. Occasionally we are lucky enough to see him on the Dr. Oz show.

[gerald]

Izzie, is this the Dr and website you are referring to? www.drweil.com/

If so, he certainly covers a lot of areas


One problem that I have with many of these studies, including this one;

They do not specify what kind of COPD they included in their study. The seem to equate bronchitis, Emphyzema, Ashtma/COPD, Pulminary Fibrosis as all the same thing and they are quite different.

[John]

Thank You Gerald for anther good article .

[izzie]

Gerald....yes that is Dr. Weil's website and apparently he has a few cookbooks out as well. I find the term COPD annoying as well because there is a difference between bronchitis, emphysema, asthma and pulmonary fibrosis.

I think the medical profession cooked it up to make things easier for themselves, but it doesn't make things easier for the average person, new to all the medical lingo. Although, I've had a couple doctors tell me that they cannot see the difference between bronchitis and emphysema on an x-ray.......stating that they both look the same. You just gotta wonder about that....or at least I do.

[gerald]

I will have to take a look at Dr Weils info, it looks interesting.

I think the COPD title is as per normal. A set of symptoms show up, gets a non specific title "COPD" and no one investigates further for years. It is only when so many people show up with differing sub symptoms that they actually start checking further and determining what is going on. Unfortunately many of the medical profession never moves beyond the initial title.

I would expect x-rays would not show them much as it does not show soft tissue in detail. To my knowledge it only serves to indicate if there are other causes/issues (cancer), Pneumonia, or excess fibrosis.

In listening to my pulminary specialist, they should be able to tell the difference between Bronchitis & emphysema with a stethoscope. It should be evident because of the airflow in the lower lungs. I believe it will be severly reduced with emphysema. With Bronchitis it may be reduced but it will be somewhat equal throughout the lungs.

Discussing COPD with my family doctor is interesting to say the least, frustrating most of the time, and down right maddening when you are trying to discuss something has has occured in the last 10 years.

[judi]

Good article and timely for me. I have wondered if some people who get pneumonia over and over are getting sick because of the ICS and it looks like that is correct. I am taking only one puff 40mcg of Qvar 2x day right now, sorry of I already mentioned that. I suspect that some people at least, may be like me and able to do with far less than is normally prescribed. It seems to help me but I don't know if that is only because I am used to it, my pulmo says I don't have an asthma component and my blood eosinophil levels are very low, I am just going to see what happens.

They can see my severe emphysema on ct scan, I have bullae (enlarged alveoli) that look like holes in my lungs.

[gerald]

I have seen a couple of writeups that suggest that corticosteroids could be connected with Pneumonia, and then there is no follow up (which I find a bit suspicious), almost as if someone does not want us to know. When you search on individual drugs you can find specific cases. I would suspect in people that are succeptable to pneumoni it migh tbe a signficiant contributing factor.

When I did a search on QVAR I find a few entries including this one:

www.patientsville.com/qvar/pneumonia.htm

and


Review: could Qvar 40 cause Pneumonia?
Summary: Pneumonia is found among people who take Qvar 40, especially for people who are female, 60+ old, have been taking the drug for 1 - 6 months, also take medication Albuterol, and have Asthma. We study 2,338 people who have side effects while taking Qvar 40 from FDA and social media. Among them, 73 have Pneumonia. Find out below who they are, when they have Pneumonia and more.
www.ehealthme.com/ds/qvar+40/pneumonia