Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube 755-8505, Japan.
Biomolecules. 2023 Jan 22;13(2):213. doi: 10.3390/biom13020213.
The use of inhaled corticosteroids (ICS) for the maintenance of bronchodilator treatment in patients with chronic obstructive pulmonary disease (COPD) is controversial. While some patients achieve clinical benefits, such as fewer exacerbations and improved symptoms, others do not, and some experience undesired side effects, such as pneumonia. Thus, we reviewed the evidence related to predictors of ICS therapy treatment response in patients with COPD. The first priority clinical markers when considering the efficacy of ICS are type 2 inflammatory biomarkers, followed by a history of suspected asthma and recurrent exacerbations. It is also necessary to consider any potential infection risk associated with ICS, and several risk factors for pneumonia when using ICS have been clarified in recent years. In this article, based on the evidence supporting the selection of ICS for COPD, we propose an ICS composite that can be added to the COPD (ICO) chart for use in clinical practice. The chart divided the type 2 biomarkers into three ranges and provided recommendations (recommend, consider, and against) by combining the history of suspected asthma, history of exacerbations, and risk of infection.
吸入性皮质类固醇（ICS）在慢性阻塞性肺疾病（COPD）患者的支气管扩张剂维持治疗中的应用存在争议。虽然一些患者确实从中获益，如减少急性加重次数和改善症状，但也有部分患者并未受益，且部分患者出现了不良反应，如肺炎。因此，我们对与 COPD 患者 ICS 治疗反应的预测因素相关的证据进行了回顾。在考虑 ICS 疗效时，首要的临床标志物是 2 型炎症生物标志物，其次是疑似哮喘病史和频繁急性加重。还需要考虑与 ICS 相关的任何潜在感染风险，近年来，已有多项与使用 ICS 相关的肺炎风险因素得到阐明。在本文中，我们根据支持 COPD 中选择 ICS 的证据，提出了一个可用于 COPD（ICO）图表的 ICS 综合评估方法，用于临床实践。该图表根据 2 型生物标志物将其分为三个范围，并通过结合疑似哮喘病史、急性加重史和感染风险来提供推荐（推荐、考虑和反对）。
