The controlled withdrawal of inhaled corticosteroids in patients with stable COPD in primary care

Abstract

There is variety in the accuracy of diagnosis, classification and long-term management of chronic obstructive pulmonary disease (COPD) in the UK. Inhaled corticosteroids (ICSs) are habitually incorrectly prescribed for patients with COPD. Evidence supporting this practice has been considered ambivalent, and more recent guidance recommends that long-acting bronchodilators are the mainstay of treatment in patients with this disease. However, there are disparities in the guidelines and in practice and ICSs are repeatedly over-used. Consequently, ICSs should be used with caution in specific COPD patients who fit the criteria. Measured withdrawal of ICSs in such patients will support safe prescribing and evidence-based management and reduce the risk of adverse effects, thus delivering quality improvement in practice. This article will provide a brief review of the evidence around the use of ICSs in COPD. It will emphasise the evidence reinforcing the safe and effective discontinuation of ICS therapy in a subgroup of patients in primary care with stable COPD, in whom ICS therapy may not be indicated, and will consider a treatment paradigm that outlines guidance on COPD therapy inhaler step-down. The implementation process undertaken in practice will be critically evaluated, providing preliminary data of results to date.