Withdrawal of inhaled glucocorticoids and exacerbations of COPD.

@article{Magnussen2014WithdrawalOI,
  title={Withdrawal of inhaled glucocorticoids and exacerbations of COPD.},
  author={Helgo Magnussen and Bernd G. Disse and Roberto Rodr{\'i}guez-Rois{\'i}n and Anne M Kirsten and Henrik Watz and Kay Tetzlaff and Lesley Towse and Helen Finnigan and Ronald Dahl and Marc Decramer and Pascal Chanez and Emiel F. M. Wouters and Peter M A Calverley},
  journal={The New England journal of medicine},
  year={2014},
  volume={371 14},
  pages={
          1285-94
        }
}
BACKGROUND Treatment with inhaled glucocorticoids in combination with long-acting bronchodilators is recommended in patients with frequent exacerbations of severe chronic obstructive pulmonary disease (COPD). However, the benefit of inhaled glucocorticoids in addition to two long-acting bronchodilators has not been fully explored. METHODS In this 12-month, double-blind, parallel-group study, 2485 patients with a history of exacerbation of COPD received triple therapy consisting of tiotropium… 

Figures and Tables from this paper

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TLDR
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Spirometric changes during exacerbations of COPD: a post hoc analysis of the WISDOM trial
TLDR
Mean lung function starts to decline prior to the first reported symptoms of an exacerbation, and does not recover to pre-exacerbation levels 8 weeks after the event, and a similar pattern was seen in moderate and severe exacerbations when analysed separately.
Weaning from inhaled corticosteroids in COPD: the evidence
TLDR
Evidence is mounting that such extensive use of ICS is discrepant with COPD treatment guidelines and may be inappropriate in a subset of these users, who remain symptomatic after regular use of one or two long-acting bronchodilators.
Discontinuation of therapy among COPD patients who experience an improvement in exacerbation status
TLDR
The extensive use of ICS and the relatively high persistence to ICS-containing regimens in individuals who had a decrease in exacerbation occurrence highlight a need for the development and implementation of de-escalation strategies in clinical practice.
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