PMID- 30214177
OWN - NLM
STAT- MEDLINE
DCOM- 20190123
LR  - 20240330
IS  - 1178-2005 (Electronic)
IS  - 1176-9106 (Print)
IS  - 1176-9106 (Linking)
VI  - 13
DP  - 2018
TI  - Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their 
      role in therapy?
PG  - 2587-2601
LID - 10.2147/COPD.S172240 [doi]
AB  - Inhaled corticosteroids (ICSs) are a mainstay of COPD treatment for patients with 
      a history of exacerbations. Initial studies evaluating their use as monotherapy 
      failed to show an effect on rate of pulmonary function decline in COPD, despite 
      improvements in symptoms and reductions in exacerbations. Subsequently, ICS use 
      in combination with long-acting beta(2)-agonists (LABAs) was shown to provide 
      improved reductions in exacerbations, lung function, and health status. ICS-LABA 
      combination therapy is currently recommended for patients with a history of 
      exacerbations despite treatment with long-acting bronchodilators alone. The 
      presence of eosinophilic bronchial inflammation, detected by high blood 
      eosinophil levels or a history of asthma or asthma-COPD overlap, may define a 
      population of patients in whom ICSs may be of particular benefit. Prospective 
      clinical studies to determine an appropriate threshold of eosinophil levels for 
      predicting the beneficial effects of ICSs are needed. Further study is also 
      required in COPD patients who continue to smoke to assess the impact of cell- and 
      tissue-specific changes on ICS responsiveness. The safety profile of ICSs in COPD 
      patients is confounded by comorbidities, age, and prior use of systemic 
      corticosteroids. The risk of pneumonia in patients with COPD is increased, 
      particularly with more advanced age and worse disease severity. ICS-containing 
      therapy also has been shown to increase pneumonia risk; however, differences in 
      study design and the definition of pneumonia events have led to substantial 
      variability in risk estimates, and some data indicate that pneumonia risk may 
      differ by the specific ICS used. In summary, treatment with ICSs has a role in 
      dual and triple therapy for COPD to reduce exacerbations and improve symptoms. 
      Careful assessment of COPD phenotypes related to risk factors, triggers, and 
      comorbidities may assist in individualizing treatment while maximizing the 
      benefit-to-risk ratio of ICS-containing COPD treatment.
FAU - Tashkin, Donald P
AU  - Tashkin DP
AD  - Department of Medicine, David Geffen School of Medicine, University of 
      California, Los Angeles, CA, USA, dtashkin@mednet.ucla.edu.
FAU - Strange, Charlie
AU  - Strange C
AD  - Department of Pulmonary and Critical Care Medicine, Medical University of South 
      Carolina, Charleston, SC, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180827
PL  - New Zealand
TA  - Int J Chron Obstruct Pulmon Dis
JT  - International journal of chronic obstructive pulmonary disease
JID - 101273481
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Adrenergic beta-2 Receptor Agonists)
RN  - 0 (Bronchodilator Agents)
SB  - IM
MH  - Administration, Inhalation
MH  - Adrenal Cortex Hormones/*administration & dosage/therapeutic use
MH  - Adrenergic beta-2 Receptor Agonists/therapeutic use
MH  - Bronchodilator Agents/therapeutic use
MH  - Disease Progression
MH  - Drug Therapy, Combination/methods
MH  - Eosinophils
MH  - Humans
MH  - Pneumonia/etiology
MH  - Prospective Studies
MH  - Pulmonary Disease, Chronic Obstructive/complications/*drug therapy
PMC - PMC6118265
OTO - NOTNLM
OT  - COPD
OT  - bronchodilators
OT  - dual/triple therapy
OT  - inhaled corticosteroids
OT  - pneumonia
OT  - safety
COIS- Disclosure DPT has served on advisory boards for AstraZeneca, Novartis, and 
      Sunovion; as a speaker for Boehringer Ingelheim, AstraZeneca, and Sunovion; and 
      as a consultant for Theravance/Innoviva. CS has current, past, or pending grants 
      in COPD from Adverum, the Alpha-1 Foundation, BTG, CSL Behring, Grifols, MatRx, 
      NIH, Novartis, PneumRx, and Shire. He consults for Abeona, AstraZeneca, CSA 
      Medical, CSL Behring, GlaxoSmithKline, Grifols, and Uptake Medical on COPD. The 
      authors report no other conflicts of interest in this work.
EDAT- 2018/09/15 06:00
MHDA- 2019/01/24 06:00
PMCR- 2018/08/27
CRDT- 2018/09/15 06:00
PHST- 2018/09/15 06:00 [entrez]
PHST- 2018/09/15 06:00 [pubmed]
PHST- 2019/01/24 06:00 [medline]
PHST- 2018/08/27 00:00 [pmc-release]
AID - copd-13-2587 [pii]
AID - 10.2147/COPD.S172240 [doi]
PST - epublish
SO  - Int J Chron Obstruct Pulmon Dis. 2018 Aug 27;13:2587-2601. doi: 
      10.2147/COPD.S172240. eCollection 2018.