Rossi Andrea, Guerriero Massimo, Corrado Antonio
Pulmonary Unit, General Hospital and University of Verona, Verona, Italy.
Respir Res. 2014 Jul 8;15(1):77. doi: 10.1186/1465-9921-15-77.
It has been suggested that withdrawal of inhaled corticosteroids (ICS) in COPD patients on maintenance treatment results in deterioration of symptoms, lung function and exacerbations. The aim of this real-life, prospective, multicentric study was to investigate whether withdrawal of ICS in COPD patients at low risk of exacerbation is linked to a deterioration in lung function and symptoms and to a higher frequency of exacerbations.
914 COPD patients, on maintenance therapy with bronchodilators and ICS, FEV1>50% predicted, and <2 exacerbations/year were recruited. Upon decision of the primary physicians, 59% of patients continued their ICS treatment whereas in 41% of patients ICS were withdrawn and regular therapy was continued with long-acting bronchodilators mostly (91% of patients). FEV1, CAT (COPD Assessment Test), and occurrence of exacerbations were measured at the beginning (T0) and at the end (T6) of the 6 months observational period.
816 patients (89.3%) concluded the study. FEV1, CAT and exacerbations history were similar in the two groups (ICS and no ICS) at T0 and at T6. We did not observe any deterioration of lung function symptoms, and exacerbation rate between the two groups at T0 and T6.
We conclude that the withdrawal of ICS, in COPD patients at low risk of exacerbation, can be safe provided that patients are left on maintenance treatment with long-acting bronchodilators.
有研究表明，慢性阻塞性肺疾病（COPD）维持治疗患者停用吸入性糖皮质激素（ICS）会导致症状恶化、肺功能下降及急性加重次数增加。本项真实、前瞻性、多中心研究旨在探讨急性加重风险较低的COPD患者停用ICS是否与肺功能和症状恶化以及更高的急性加重频率相关。
招募了914例接受支气管扩张剂和ICS维持治疗、预测第一秒用力呼气容积（FEV1）>50%且每年急性加重次数<2次的COPD患者。根据主治医生的决定，59%的患者继续使用ICS治疗，而41%的患者停用ICS，主要继续使用长效支气管扩张剂进行常规治疗（91%的患者）。在6个月观察期开始时（T0）和结束时（T6）测量FEV1、慢性阻塞性肺疾病评估测试（CAT）以及急性加重的发生情况。
816例患者（89.3%）完成了研究。两组（使用ICS组和未使用ICS组）在T0和T6时的FEV1、CAT及急性加重病史相似。我们未观察到两组在T0和T6时肺功能症状有任何恶化以及急性加重率有差异。
我们得出结论，对于急性加重风险较低的COPD患者，只要继续使用长效支气管扩张剂进行维持治疗，停用ICS可能是安全的。
