Pragmatic trial on inhaled corticosteroid withdrawal in patients with COPD in general practice

• Verfasst von: van den Bemt, Lisette [VerfasserIn]
• Verfasst von: van den Nieuwenhof, Lotte [VerfasserIn]
• Verfasst von: Rutjes, Anne [VerfasserIn]
• Verfasst von: van der Meer, Victor [VerfasserIn]
• Verfasst von: Stege, Gerben [VerfasserIn]
• Verfasst von: Wensing, Michel [VerfasserIn]
• Verfasst von: Teichert, Martina [VerfasserIn]
• Verfasst von: Schermer, Tjard [VerfasserIn]
• Titel: Pragmatic trial on inhaled corticosteroid withdrawal in patients with COPD in general practice
• Verf.angabe: Lisette van den Bemt, Lotte van den Nieuwenhof, Anne Rutjes, Victor van der Meer, Gerben Stege, Michel Wensing, Martina Teichert and Tjard Schermer
• E-Jahr: 2020
• Jahr: 09 October 2020
• Umfang: 8 S.
• Fussnoten: Gesehen am 08.12.2020
• Titel Quelle: Enthalten in: npj Primary care respiratory medicine
• Ort Quelle: [S.l.] : Nature Publ. Group, 2014
• Jahr Quelle: 2020
• Band/Heft Quelle: 30(2020,1) Artikel-Nummer 43, 8 Seiten
• ISSN Quelle: 2055-1010
• DOI: doi:10.1038/s41533-020-00198-5
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: care
• Sach-SW: disease
• Sach-SW: exacerbations
• Sach-SW: fluticasone
• Sach-SW: indacaterol
• Sach-SW: questionnaire
• Sach-SW: salmeterol/fluticasone
• Sach-SW: wisdom
• K10plus-PPN: 1742242820

Abstract

The therapeutic value of inhaled corticosteroids (ICSs) for COPD is limited. In published RCTs, ICS could be withdrawn in COPD patients without increasing exacerbation risk when bronchodilator treatment is optimized. Here we report on the feasibility and risks of ICS withdrawal in Dutch general practice for COPD patients without an indication for ICSs. In our pragmatic trial, general practitioners decided autonomously which of their COPD patients on ICS treatment could stop this, how this was done, and whether additional bronchodilator therapy was needed. We recruited 62 COPD patients (58 analysed) who were eligible for ICS withdrawal in 79 practices. In 32 patients (55.2%, 95% CI: 42.5-67.3%) ICS was withdrawn successfully, 19 (32.8%, 95% CI: 22.1-45.6%) restarted ICS treatment within six months, 12 patients (20.7%, 95% CI: 12.3-32.8%) had a moderate exacerbation, and one patient had a severe exacerbation. ICS withdrawal was successful in just over half of the patients with COPD without an indication for ICS.