Chalmers James D, Laska Irena F, Franssen Frits M E, Janssens Wim, Pavord Ian, Rigau David, McDonnell Melissa J, Roche Nicolas, Sin Don D, Stolz Daiana, Suissa Samy, Wedzicha Jadwiga, Miravitlles Marc
School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
Task Force co-chairs.
Eur Respir J. 2020 Jun 4;55(6). doi: 10.1183/13993003.00351-2020. Print 2020 Jun.
Inhaled corticosteroids (ICS) combined with bronchodilators can reduce the frequency of exacerbations in some patients with chronic obstructive pulmonary disease (COPD). There is evidence, however, that ICS are frequently used in patients where their benefit has not been established. Therefore, there is a need for a personalised approach to the use of ICS in COPD and to consider withdrawal of ICS in patients without a clear indication. This document reports European Respiratory Society recommendations regarding ICS withdrawal in patients with COPD.Comprehensive evidence synthesis was performed to summarise all available evidence relevant to the question: should ICS be withdrawn in patients with COPD? The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence synthesis was discussed and recommendations formulated by a committee with expertise in COPD and guideline methodology.After considering the balance of desirable and undesirable consequences, quality of evidence, and feasibility and acceptability of interventions, the guideline panel made: 1) conditional recommendation for the withdrawal of ICS in patients with COPD without a history of frequent exacerbations, 2) strong recommendation not to withdraw ICS in patients with blood eosinophil counts ≥300 eosinophils·µL and 3) strong recommendation to treat with one or two long-acting bronchodilators if ICS are withdrawn.A conditional recommendation indicates that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention.
吸入性糖皮质激素（ICS）联合支气管扩张剂可降低部分慢性阻塞性肺疾病（COPD）患者的急性加重频率。然而，有证据表明，ICS经常被用于未证实其获益的患者。因此，有必要采用个性化方法来使用ICS治疗COPD，并考虑在无明确指征的患者中停用ICS。本文报告了欧洲呼吸学会关于COPD患者停用ICS的建议。进行了全面的证据综合分析，以总结与以下问题相关的所有现有证据：COPD患者是否应停用ICS？采用GRADE（推荐分级、评估、制定和评价）方法对证据进行评估，并将结果总结在证据概况中。由具有COPD和指南制定方法专业知识的委员会讨论证据综合分析结果并制定建议。在考虑了有利和不利后果的平衡、证据质量以及干预措施的可行性和可接受性之后，指南小组提出：1）有条件推荐在无频繁急性加重病史的COPD患者中停用ICS；2）强烈推荐在血液嗜酸性粒细胞计数≥300个嗜酸性粒细胞·微升的患者中不要停用ICS；3）如果停用ICS，强烈推荐使用一种或两种长效支气管扩张剂进行治疗。有条件推荐表明，对于干预措施有利和不利后果的平衡存在不确定性，并且明智的患者对于是否进行特定干预可能会做出不同选择。
