From the Guidelines
Inhaled Corticosteroids in COPD Exacerbation
Inhaled Corticosteroids (ICS) are not routinely indicated for the treatment of Chronic Obstructive Pulmonary Disease (COPD) exacerbations in an inpatient setting, unless the patient has a history of asthma or a significant eosinophilic component 1.
- The use of ICS in COPD exacerbations is generally reserved for patients with a history of frequent exacerbations or eosinophilic COPD, where addition of ICS such as fluticasone (250-500 mcg twice daily) or budesonide (200-400 mcg twice daily) to bronchodilator therapy may be considered 1.
- The duration of ICS treatment in this setting is typically limited to the acute exacerbation period, typically 7-14 days.
- It is essential to note that systemic corticosteroids, not ICS, are the preferred treatment for COPD exacerbations in the inpatient setting, as they have been shown to be effective in reducing treatment failure and improving outcomes 1.
- The choice of treatment should be individualized based on the patient's specific needs and medical history, and guided by evidence-based guidelines 1.
From the Research
Inhaled Corticosteroids in COPD Exacerbation
- The use of inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD) exacerbation is debated, with recent studies suggesting that ICS may be beneficial in reducing exacerbations in patients with frequent or severe exacerbations 2, 3.
- However, the European Medicines Agency and US Food and Drug Administration have rejected the suggestion of a mortality benefit associated with ICS in COPD patients 2.
- Observational evidence suggests that dual bronchodilation is associated with better clinical outcomes than triple therapy in a broad population of patients with COPD and infrequent exacerbations 2.
- Guidelines recommend that ICS-containing maintenance therapy should be reserved for patients with frequent or severe exacerbations and high blood eosinophils, or those with concomitant asthma 2, 3, 4.
Patient Selection for ICS Therapy
- The decision to prescribe ICS should be based on individual patient characteristics, such as frequency of exacerbations, blood eosinophil counts, and presence of concomitant asthma 2, 3, 5, 6.
- The BERN acronym (Bronchiolitis, Eosinophilia, Responsiveness to bronchodilator, and Non-smoker) may be useful in selecting patients who are likely to benefit from ICS therapy 6.
- ICS use is frequently associated with common local adverse events, such as dysphonia, oral candidiasis, and increased risk of pneumonia, and should be carefully evaluated in stable COPD patients 4.
Inpatient Setting
- There is limited evidence specifically addressing the use of ICS in COPD exacerbation in an inpatient setting.
- However, the principles of patient selection and careful evaluation of ICS use, as outlined in the guidelines and studies, are likely to apply in both inpatient and outpatient settings 2, 3, 4.