A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients

Smit Patel (Lead / Corresponding author), Scott Dickinson, Kevin Morris, Helen F. Ashdown, James D. Chalmers

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)
29 Downloads (Pure)

Abstract

Inhaled corticosteroid (ICS) therapy is widely prescribed without a history of exacerbations and consensus guidelines suggest withdrawal of ICS in these patients would reduce the risk of side effects and promote cost-effective prescribing. The study describes the prescribing behaviour in the United Kingdom (UK) in relation to ICS withdrawal and identifies clinical outcomes following withdrawal using primary and secondary care electronic health records between January 2012 and December 2017. Patients with a history ≥12 months' exposure who withdrew ICS for ≥6 months were identified into two cohorts; those prescribed a long-acting bronchodilator maintenance therapy and those that were not prescribed any maintenance therapy. The duration of withdrawal, predictors of restarting ICS, and clinical outcomes were compared between both patient cohorts. Among 76,808 patients that had ≥1 prescription of ICS in the study period, 11,093 patients (14%) withdrew ICS therapy at least once during the study period. The median time without ICS was 9 months (IQR 7-14), with the majority (71%) receiving subsequent ICS prescriptions after withdrawal. Patients receiving maintenance therapy with a COPD review at withdrawal were 28% less likely to restart ICS (HR: 0.72, 95% CI 0.61, 0.85). Overall, 69% and 89% of patients that withdrew ICS had no recorded exacerbation event or COPD hospitalisation, respectively, during the withdrawal. This study provides evidence that most patients withdrawing from ICS do not experience COPD exacerbations and withdrawal success can be achieved by carefully planning routine COPD reviews whilst optimising the use of available maintenance therapies.

Original languageEnglish
Article number25
Number of pages11
JournalNPJ Primary Care Respiratory Medicine
Volume32
Issue number1
DOIs
Publication statusPublished - 20 Jul 2022

Keywords

  • Administration, Inhalation
  • Adrenal Cortex Hormones/therapeutic use
  • Bronchodilator Agents/therapeutic use
  • Cohort Studies
  • Humans
  • Pulmonary Disease, Chronic Obstructive/drug therapy

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice
  • Pulmonary and Respiratory Medicine

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