Patients with COPD who are not having frequent exacerbations can safely be taken off inhaled corticosteroids (ICS) as long as their blood eosinophil count is less than 300 μL−1, new guidance from the European Respiratory Society recommends.
Those patients who are advised to stop ICS treatment should instead be treated with one or two long-acting bronchodilators, the ERS advises.
It is hoped the clear recommendations will reduce the number of patients with COPD prescribed ICS when they are not indicated.
Speaking with the limbic, guideline author Professor James Chalmers from the University of Dundee, Scotland, said the evidence was clear that ICS only work in a small proportion of patients with COPD and their disease would be better controlled with bronchodilators.
His research has shown that even with improvements over time in the proportion of COPD patients, inappropriately prescribed ICS is still too high at around 50%.
“We need a solution that can safely identify patients who can stop their steroid and go onto a more effective regimen without taking ICS away from the 20% of patients who do well with a steroid,” he said.
The guideline committee identified four randomised controlled trials looking at clinical outcomes of stopping steroid use over at least six months.
They concluded that although the evidence is limited due to the small number of studies that met their criteria.