Discontinuation Schedule of Inhaled Corticosteroids in Patients With Chronic Obstructive Pulmonary Disease

• Published in: Federal practitioner 2023-12, Vol.40 (12), p.398-403
• Main Authors: Steeves, Molly E, Runeberg, Haley A, Johnson, Savannah R, Kelly, Kevin C
• Format: Article
• Language: English
• ISSN: 1078-4497; 1945-337X
• DOI: 10.12788/fp.0442

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.