Discontinuation Schedule of Inhaled Corticosteroids in Patients With Chronic Obstructive Pulmonary Disease.

Molly E Steeves, Haley A Runeberg, Savannah R Johnson, Kevin C Kelly
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Abstract

Background: Long-term use of inhaled corticosteroids (ICSs) is associated with several potential adverse effects. While patients unlikely to benefit should stop ICS use, abrupt discontinuation may result in an increased risk of chronic obstructive pulmonary disease (COPD) exacerbation. Stepwise tapering may reduce this risk but data are limited, and there is no consensus on the likelihood of COPD exacerbations following ICS discontinuation. The North Texas Veterans Affairs Health Care System conducted a single center, retrospective cohort study to evaluate the rate of COPD exacerbations following the discontinuation of ICS therapy using different schedules of discontinuation.

Methods: Data were collected from the electronic health records of patients aged ≥ 40 years with a diagnosis of COPD who were on a stable dose of an ICS for ≥ 1 year that was subsequently discontinued with a last documented fill date between January 10, 2021 and September 1, 2021. Eligible patients were followed for COPD exacerbations that resulted in hospitalization until November 1, 2022. Descriptive statistics were used to evaluate characteristics of patients who experienced an exacerbation.

Results: Seventy-five patients were included: 5 (7%) experienced an exacerbation following ICS discontinuation. Age, sex, race, and ethnicity were similar for those patients who did vs did not have an exacerbation. Unexpectedly, the mean baseline eosinophil count for patients with an exacerbation was 92 cells/μL compared with 227.4 cells/μL for those without an exacerbation. Nine patients had their ICS tapered gradually, and none of them experienced an exacerbation.

Conclusions: Study findings suggest that there is a relatively low risk of COPD exacerbation following ICS discontinuation, regardless of whether a taper was performed. This result may indicate that it is reasonable to abruptly discontinue ICS in eligible patients.

慢性阻塞性肺病患者停用吸入性皮质类固醇的时间表。
背景:长期使用吸入式皮质类固醇(ICS)会产生一些潜在的不良反应。虽然不太可能获益的患者应停止使用 ICS,但突然停药可能会导致慢性阻塞性肺病(COPD)加重的风险增加。逐步减量可能会降低这种风险,但数据有限,而且对于停用 ICS 后慢性阻塞性肺病(COPD)加重的可能性还没有达成共识。北德克萨斯退伍军人事务医疗保健系统开展了一项单中心回顾性队列研究,以评估采用不同的停药计划停用 ICS 治疗后慢性阻塞性肺疾病的加重率:研究人员从年龄≥ 40 岁、诊断为慢性阻塞性肺病的患者的电子病历中收集数据,这些患者曾使用稳定剂量的 ICS 治疗≥ 1 年,随后停用了 ICS,最后记录的填充日期在 2021 年 1 月 10 日至 2021 年 9 月 1 日之间。在 2022 年 11 月 1 日前,对符合条件的慢性阻塞性肺病患者因慢性阻塞性肺病加重而住院治疗的情况进行随访。采用描述性统计方法评估病情恶化患者的特征:结果:共纳入 75 名患者:结果:共纳入 75 名患者:5 人(7%)在停用 ICS 后病情加重。出现与未出现病情恶化的患者的年龄、性别、种族和民族相似。意想不到的是,病情恶化患者的平均基线嗜酸性粒细胞计数为 92 cells/μL,而未出现病情恶化的患者为 227.4 cells/μL。九名患者的 ICS 逐渐减少,但没有一人出现病情加重:研究结果表明,无论是否减量,停用 ICS 后慢性阻塞性肺疾病恶化的风险相对较低。这一结果可能表明,对符合条件的患者突然停用 ICS 是合理的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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