Steeves Molly E, Runeberg Haley A, Johnson Savannah R, Kelly Kevin C
Veterans Affairs North Texas Health Care System, Dallas.
Fed Pract. 2023 Dec;40(12):398-403. doi: 10.12788/fp.0442. Epub 2023 Dec 13.
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.
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.
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.
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.
长期使用吸入性糖皮质激素（ICS）与多种潜在不良反应相关。对于不太可能从中获益的患者，应停用ICS，但突然停药可能会增加慢性阻塞性肺疾病（COPD）急性加重的风险。逐步减量可能会降低这种风险，但数据有限，且对于ICS停药后COPD急性加重的可能性尚无共识。北德克萨斯退伍军人事务医疗保健系统进行了一项单中心回顾性队列研究，以评估采用不同停药方案停用ICS治疗后COPD急性加重的发生率。
从年龄≥40岁、诊断为COPD且稳定剂量使用ICS≥1年、随后于2021年1月10日至2021年9月1日期间停药且有最后一次记录用药日期的患者的电子健康记录中收集数据。符合条件的患者被随访至2022年11月1日，观察导致住院的COPD急性加重情况。使用描述性统计方法评估发生急性加重的患者的特征。
共纳入75例患者：5例（7%）在停用ICS后发生了急性加重。发生急性加重和未发生急性加重的患者在年龄、性别、种族和民族方面相似。出乎意料的是，发生急性加重的患者的平均基线嗜酸性粒细胞计数为92个/μL，而未发生急性加重的患者为227.4个/μL。9例患者的ICS逐渐减量，其中无一例发生急性加重。
研究结果表明，无论是否进行减量，停用ICS后COPD急性加重风险相对较低。这一结果可能表明，在符合条件的患者中突然停用ICS是合理的。
