Department of Medicine, Zealand University Hospital, Roskilde, Denmark.
Department of Medicine, Hospital Little Belt, Vejle, Denmark.
Int J Chron Obstruct Pulmon Dis. 2021 Mar 26;16:807-815. doi: 10.2147/COPD.S294217. eCollection 2021.
Inhaled corticosteroids (ICS) are widely used in the treatment of chronic obstructive pulmonary disease (COPD), but recent studies have raised doubts whether all COPD patients will benefit from ICS. This study evaluates in a real-life setting the effects of ICS withdrawal in patients with COPD.
The study was a prospective intervention study following patients with COPD for 6 months after abrupt withdrawal of ICS. FEV1 (L), blood eosinophilic count (x10E9/L) and number of exacerbations were measured at baseline, 1, 3 and 6 months after ICS withdrawal.
Ninety-six patients (56 females (57.4%), mean age 70 years (51-94 years)) with COPD were included in the study. Eleven patients were excluded during the study period (7 patients died, 4 patients withdrew their consent during the study period). During the 6 months, 51 patients (60%) had resumed treatment with ICS, of whom 34 patients (68%) experienced an exacerbation during follow-up. No significant decline in FEV1 was seen in this group between baseline and after 6 months (ΔFEV1 0.07 L, p = 0.09). In the remaining 34 patients (40%) without ICS after 6 months of follow-up, 15 patients (44.1%) experienced an exacerbation. No significant decline was seen in FEV1 at baseline and after 6 months (ΔFEV1 0.04 L, p = 0.28). There were no statistically significant differences between the two groups in age (70.5 vs 69.6 years, p = 0.53), nor between FEV1 at baseline (0.96 L vs 1.00 L, p = 0.63) or eosinophilic count (0.25 x10E9/L vs 0.17 x10E9/L, p = 0.07).
Abrupt withdrawal of ICS was possible in some patients. However, more than half of the patients resumed ICS during follow-up. Based on results from our study we were not able to foresee - from neither history of exacerbations nor eosinophilic count - whom will be able to manage without ICS and who will resume treatment with ICS.
吸入性皮质类固醇（ICS）广泛用于治疗慢性阻塞性肺疾病（COPD），但最近的研究对所有 COPD 患者是否都能从 ICS 中获益提出了质疑。本研究在真实环境中评估了 COPD 患者停用 ICS 的效果。
该研究是一项前瞻性干预研究，对突然停用 ICS 后 6 个月的 COPD 患者进行随访。在 ICS 停药前、停药后 1、3 和 6 个月时测量 FEV1（L）、血嗜酸性粒细胞计数（x10E9/L）和加重次数。
96 例（56 例女性（57.4%），平均年龄 70 岁（51-94 岁））COPD 患者纳入研究。研究期间有 11 例患者被排除（7 例死亡，4 例在研究期间撤回同意）。在 6 个月期间，51 例患者（60%）重新开始 ICS 治疗，其中 34 例（68%）在随访期间出现加重。在这组患者中，FEV1 在基线和 6 个月后没有明显下降（ΔFEV1 0.07 L，p=0.09）。在 6 个月随访后未继续使用 ICS 的 34 例患者（40%）中，15 例（44.1%）出现加重。FEV1 在基线和 6 个月后没有明显下降（ΔFEV1 0.04 L，p=0.28）。两组患者在年龄（70.5 岁 vs 69.6 岁，p=0.53）、FEV1 基线水平（0.96 L vs 1.00 L，p=0.63）或嗜酸性粒细胞计数（0.25 x10E9/L vs 0.17 x10E9/L，p=0.07）方面均无统计学差异。
在一些患者中可以突然停用 ICS。然而，在随访期间，超过一半的患者恢复了 ICS 治疗。根据我们的研究结果，我们无法预测（无论是基于加重史还是嗜酸性粒细胞计数）哪些患者可以停用 ICS，哪些患者将恢复 ICS 治疗。
