- ICS use in COPD has the potential to reduce exacerbations 1
- However it is associated with side effects, including pneumonia and this must be balanced against the benefits of ICS 1
- Therefore it's key to have a discussion with your patient, as ICS use must be personalised 2
When should you consider the use of ICS?
- ICS/long-acting beta agonist (LABA) combination therapy is more effective than the individual components in improving lung function, health status and reducing exacerbations in patients with moderate to very severe COPD. 1
- Combining ICS with a long-acting muscarinic antagonist (LAMA)/LABA in a triple therapy is more effective in patients with high exacerbation risk compared with a LAMA/LABA dual therapy.1,3
- LAMA/LABA is recommended for patients who remain breathless or have exacerbations despite using a short acting bronchodilator
- ICS/LABA is recommended for patients with COPD and asthmatic features/features suggesting steroid responsiveness and LAMA/LABA is recommended in patients without these features
- ICS/LAMA/LABA is recommended for patients with COPD and asthmatic features/features suggesting steroid responsiveness, who remain breathless or have exacerbations despite taking ICS/LABA
- Importantly, the risk of side effects, including pneumonia, should be discussed with patients who take ICS as part of their COPD therapy
Clinical trial evidence suggests that ICS is associated with a higher prevalence of:1 oral candidiasis, hoarse voice, skin bruising, pneumonia.
But other factors that can increase the risk of pneumonia in patients taking ICS therapies include:1
- Current smokers
- Aged ≥55 years
- Have a history of exacerbations or pneumonia
- Body mass index <25 kg/m2
- Poor Medical Research Council (MRC) dyspnoea grade and/or severe airflow limitation
Who is most likely to benefit from ICS use?
So in summary is ICS suitable for my patient?
Considerations for ICS use are summarised below and can help guide you when making a decision about ICS.
|Likely to benefit||Consider use||Avoid use|
|▪️ ≥2 moderate exacerbations/year*||▪️ 1 moderate exacerbation/year*||▪️ Repeated pneumonia events|
|▪️ History of hospitalisation(s) for exacerbation*||▪️ Blood eosinophils 100-300 cells/μL||▪️ Blood eosinophils <100 cells/μL|
|▪️ Blood eosinophils >300 cells/μL||▪️ History of mycobacterial infection|
|▪️ History of asthma or currently asthmatic|
- GOLD. Gold Initiative For The Diagnosis, Management, And Prevention of Chronic Obstructive Pulmonary Disease (2019 Report). 2019.
- Agusti A, Fabbri LM, Singh D, et al. Inhaled corticosteroids in COPD: Friend or foe? Eur Respir J. 2018;52(6).
- Lipson DA, Barnhart F, Brealey N, et al. Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. N Engl J Med. 2018.
- NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. 2018