Abstract:In chronic obstructive pulmonary disease (COPD), treatment with inhaled corticosteroids (ICSs) in combination with long acting beta-2-agonists (LABA) or LABA/long-acting muscarinic antagonists (LAMA) is used in order to reduce exacerbations. Treatment with ICS is, however, associated with side effects such as oropharyngeal candidiasis, skin thinning or easy bruising and pneumonia. The aim of this review was to investigate when to use ICS in COPD and to compare the effectiveness and safety of different ICSs. St… Show more
“…The AER was significantly reduced by 24% (RR: 0.76 [0.65, 0.89]) and by 33% (RR: 0.67 [0.46, 0.96]) with ICS-containing triple therapy compared with LABA/LAMA and LAMA, respectively. Skin thickening, candidiasis and pneumonia were the side effects associated with ICS therapy, 62 while dry mouth, nausea, headache are the side-effects often associated with non-ICS therapy. 63 Figure 3 Effects of treatment on the number of patients experiencing COPD exacerbations by therapeutic regimen.…”
Background
Several large randomized clinical trials (RCTs) have assessed the efficacy and safety of inhaled corticosteroid (ICS) combination regimens versus non-ICS therapy in patients with chronic obstructive pulmonary disease (COPD) at increased risk of exacerbation risk with mixed results.
Methods
We performed a systematic literature review and meta-analysis of RCTs comparing the effect of ICS-containing combination therapy and non-ICS regimen in patients with COPD.
Results
A total of 54 RCTs (N = 57,333) reported treatment effects on various outcomes and were eligible for inclusion. Overall, the number of patients experiencing moderate/severe exacerbations was significantly lower for ICS-containing combination therapy versus non-ICS therapy (RR: 0.86 [95% CI: 0.80–0.93]). The annual rate of exacerbations was also significantly reduced by 22% (0.78 [0.72–0.86]) with ICS-containing versus non-ICS therapy. The annual rate of exacerbations requiring hospitalisation was reduced by 31% versus non-ICS therapy (0.69 [0.54–0.88]); similar reduction was observed for exacerbations requiring oral steroids (0.69 [0.66–0.73]). Overall, the effect on trough FEV1 was comparable between ICS-containing and non-ICS therapies (follow-up: 6–52 weeks); however, a significant improvement in lung function (trough FEV1) was observed for ICS/LABA versus LABA (MD: +0.04 L [0.03−0.05]) and ICS/LABA/LAMA versus LAMA (MD: +0.09 L [0.05−0.13]) regimens. In addition, a significant improvement in QoL was observed with ICS-containing versus non-ICS therapy (MD in SGRQ score: −0.90 [−1.50, −0.31]).
Conclusion
This meta-analysis demonstrated that a wide range of patients with COPD could benefit from dual and triple ICS-containing therapy.
“…The AER was significantly reduced by 24% (RR: 0.76 [0.65, 0.89]) and by 33% (RR: 0.67 [0.46, 0.96]) with ICS-containing triple therapy compared with LABA/LAMA and LAMA, respectively. Skin thickening, candidiasis and pneumonia were the side effects associated with ICS therapy, 62 while dry mouth, nausea, headache are the side-effects often associated with non-ICS therapy. 63 Figure 3 Effects of treatment on the number of patients experiencing COPD exacerbations by therapeutic regimen.…”
Background
Several large randomized clinical trials (RCTs) have assessed the efficacy and safety of inhaled corticosteroid (ICS) combination regimens versus non-ICS therapy in patients with chronic obstructive pulmonary disease (COPD) at increased risk of exacerbation risk with mixed results.
Methods
We performed a systematic literature review and meta-analysis of RCTs comparing the effect of ICS-containing combination therapy and non-ICS regimen in patients with COPD.
Results
A total of 54 RCTs (N = 57,333) reported treatment effects on various outcomes and were eligible for inclusion. Overall, the number of patients experiencing moderate/severe exacerbations was significantly lower for ICS-containing combination therapy versus non-ICS therapy (RR: 0.86 [95% CI: 0.80–0.93]). The annual rate of exacerbations was also significantly reduced by 22% (0.78 [0.72–0.86]) with ICS-containing versus non-ICS therapy. The annual rate of exacerbations requiring hospitalisation was reduced by 31% versus non-ICS therapy (0.69 [0.54–0.88]); similar reduction was observed for exacerbations requiring oral steroids (0.69 [0.66–0.73]). Overall, the effect on trough FEV1 was comparable between ICS-containing and non-ICS therapies (follow-up: 6–52 weeks); however, a significant improvement in lung function (trough FEV1) was observed for ICS/LABA versus LABA (MD: +0.04 L [0.03−0.05]) and ICS/LABA/LAMA versus LAMA (MD: +0.09 L [0.05−0.13]) regimens. In addition, a significant improvement in QoL was observed with ICS-containing versus non-ICS therapy (MD in SGRQ score: −0.90 [−1.50, −0.31]).
Conclusion
This meta-analysis demonstrated that a wide range of patients with COPD could benefit from dual and triple ICS-containing therapy.
“…A large number of clinical studies on the use of eosinophil-guided glucocorticoids have focused on long-term low-dose inhalation guidelines for stable periods. 21 The 2018 Global chronic obstructive Pulmonary Disease Initiative (GOLD) guidelines recommend the use of peripheral blood eosinophil count (PBEC) to guide the selection of inhaled steroids to prevent COPD deterioration, strongly recommended when eosinophils > 300 cells/ul, and considered for 100–300/ul. 8 Therefore, sometimes clinical medical staff may subconsciously use the rules guided by eosinophil as the rules for glucocorticoid selection in acute exacerbation, but the research population and intervention methods of the two are not consistent, so the results obtained are not necessarily similar.…”
Background
Clinicians’ selection of glucocorticoids during hospitalization of COPD patients is often based on the medical staff’s judgment of the patient’s condition, and there is no objective judgment standard. The purpose of this study was to investigate the outcome of severe COPD deterioration in patients treated with glucocorticoid and without glucocorticoid during hospitalization.
Methods
This study was an observational cohort study. Data on hospitalization with severe COPD deterioration were collected and followed up for 1 year. One year after discharge, the re-hospitalization due to COPD was collected retrospectively. The patients were divided into glucocorticoid group and control group according to whether the patients were given glucocorticoid therapy or not when they were admitted to hospital for the first time. The primary outcome was rate of future COPD exacerbations, while the secondary outcome was hospital stay, treatment cost and COPD-related readmission time. These results are analyzed by using Poisson model and Cox regression model.
Results
A total of 91 patients were enrolled in the study, including 39 in the control group and 52 in the glucocorticoid group. The annual rate of future COPD exacerbations in the glucocorticoid group was significantly lower than that in the control group (RR,0.50 [95% CI, 0.26–0.98]; P = 0.045). The risk of COPD recurrence in the glucocorticoid group was lower than that in the control group, as assessed in a time-to-first-event analysis (HR,0.46[95% CI 0.22–0.97]; P = 0.042). Subgroup analysis found that in patients with blood eosinophil <100 cells/μ l, the future annual severe exacerbation rate of glucocorticoid group was significantly lower than that in the control group (adjusted RR,0.37 [95% CI 0.17–0.83]; P = 0.016).
Conclusion
The use of glucocorticoids during hospitalization in COPD can more effectively reduce the severe deterioration of COPD than without glucocorticoids.
“…Inhaled corticosteroid, the treatment for both asthma and COPD, was associated with lower expression of ACE2 and TMPRSS2 [ 4 , 9 ]. Corticosteroid inhalation has been shown to suppress coronavirus replication, cytokine production and decrease both ACE2 and TMPRSS2 gene expression in asthma patients [ 4 ].…”
Background
There are various reasons for delayed positive nasopharyngeal PCR tests for coronavirus disease 2019 (COVID19) in not only asymptomatic but also severely diseased patients. The pathophysiological attributes are not known. We explore this possibility through a case report.
Case presentation
A 64-year-old male with history of pulmonary fungal infection, asthma and chronic pulmonary obstructive disease (COPD), diabetes, coronary artery disease presented with shortness of breath, fever and chest image of ground opacity, reticular interstitial thickening, highly suspicious for COVID19. However, nasopharyngeal swab tests were discordantly negative for four times in two weeks, and IgG antibody for COVID19 was also negative. However, serum IgE level was elevated. No other pathogens are identified. His symptoms deteriorated despite corticosteroid, antibiotics and bronchodilator treatment. Bronchoalveolar lavage (BAL) and open lung wedge biopsy were performed for etiology diagnosis. They demonstrated COVID19 viral RNA positive fibrosing organizing pneumonia with respiratory tract damage characterized by suspicious viral cytopathic effect, mixed neutrophilic, lymphoplasmacytic, histiocytic and eosinophilic inflammation and fibrosis besides expected asthma and COPD change. One week later, repeated COVID19 nasopharyngeal tests on day 40 and day 49 became positive.
Conclusion
Our case and literature review indicate that allergic asthma and associated high IgE level together with corticosteroid inhalation might contribute to the delayed positive nasopharyngeal swab in upper airway; COPD related chronic airways obstruction and the addition of fibrosis induced ventilator dependence and poor prognosis in COVID19 pneumonia, and should be therapeutically targeted besides antiviral therapy.
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