Inhaled glucocorticosteroids in the treatment of chronic obstructive pulmonary disease: the debate continues


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent bronchial obstruction. Chronic airway inflammation, which occurs under the influence of tobacco smoke and pollutants, is important in its development and progression. The place of inhaled glucocorticosteroids (IGCS) in the treatment of COPD is one of the most controversial issues in recent years. This article discusses the role of IGCS in the treatment of COPD. The available results of clinical studies allow to recommend these drugs in case of combination of bronchial asthma and COPD. They are also indicated for patients with frequent exacerbations of COPD, despite therapy with long-acting bronchodilators and their combinations. The most likely predictor of IGCS efficacy as a part of dual (IGCS/long-acting e2-agonists [LABA]) and triple therapy (IGCS/LABA/long-acting anticholinergic agents [LAAHA]) is the frequency of exacerbations and the eosinophil blood level. Risk/benefit ratio must be taken into account in case of administration of these drugs.

Full Text

Restricted Access

About the authors

Alexander V. Emelyanov

North-Western State Medical University n.a. I.I. Mechnikov

Email: aleksandr.emelyanov@szgmu.ru
MD, Professor, Head of the Department of Pulmonology

E. V Leshenkova

North-Western State Medical University n.a. I.I. Mechnikov

Department of Pulmonology

G. R Sergeeva

North-Western State Medical University n.a. I.I. Mechnikov

Department of Pulmonology

References

  1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. NHLBI/WHO workshop report. National Heart, Lung, and Blood Institute, update 2019. www.goldcopd.com (access date 18.03.19).
  2. Stnescu D, Sanna A, Veriter C, et al. Airways obstruction, chronic expectoration, and rapid decline of FEV1 in smokers are associated with increased levels of sputum neutrophils. Thorax. 1996;51:267-71.
  3. Cao C, Wang R, Wang J, et al. Body Mass Index and Mortality in Chronic Obstructive Pulmonary Disease: A Meta-Analysis. PLoS One. 2012; 7(8):e4389. Doi: 10.1371 /journal. pone.0043892.
  4. King P Inflammation in chronic obstructive pulmonary disease and its role in cardiovascular disease and lung cancer Clin Transl Med. 2015;4:26. doi: 10.1186/s40169-015-0068-z.
  5. Agusti A., Edwards L.D., Rennard S.I., et al. Persistent Systemic Inflammation is Associated with Poor Clinical Outcomes in COPD: A Novel Phenotype. PLoS ONE. 2012;7(5):e37483. doi: 10.1371/journal.pone.0037483.
  6. Barnes P. Corticosteroid resistance in patients with asthma and chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2013;131:636-45.
  7. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, November 1986. Am Rev Respir Dis. 1987;136(1):225-44.
  8. Burge PS. EUROSCOP ISOLDE and the Copenhagen City Lung Study. Thorax. 1999;54(4):287-88.
  9. Burge FIS., Calverley PM.A., Jones PW, et al. Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial BMJ. 2000;320(7245): 1297-303.
  10. Pauwels R.A., Lofdahl C.-G., Laitinen L.A., et al. Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. N Engl J Med. 1999;340(25):1948-53.
  11. The Lung Health Study Research Group. Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease. N Eng J Med. 2000;343(26):1902-909.
  12. Vestbo J., Sorensen T., Lange P, et al. long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease. Lancet. 1999;353(9167):1819-23.
  13. Alsaeedi A., Sin D.D., McAlister F.A. The effect of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials. Am J Med. 2002;113(1):56-65.
  14. Barnes N.C., Qiu Y.S., Pavord I.D., et al. Antiinflammatory effects of salmeterol/fluticasone propionate in chronic obstructive lung disease. Am J Respir Crit Care Med. 2006;173:736-43.
  15. Jen R., Rennard S.I., Sin D.D. Effects of inhaled corticosteroids on airway inflammation in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J COPD. 2012;7:587-95.
  16. Szafranski W, Cukier A., Ramiez A., et al. Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease. Eur Respir J. 2003;21(1):74-81.
  17. Calverley P, Pauwels R., Vestbo J., et al. Combined salmeterol and fluticason in the treatment of chronic obstructive pulmonary disease: a randomized controlled trial. Lancet. 2003;361(9356): 449-56.
  18. Calverley P, Boonswat W., Cseke Z., et al. Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease. Eur Respir J. 2003;22(6):912-19.
  19. Calverley PM.A, Anderson J.A., Celli B., et al. Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356:775-89. Doi: 10.1056/ NEJMoa1516385.
  20. Wedzicha J.A., Calverley PM.A., Seemungal T., et al. The Prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med. 2008;177:19-26. Doi:10.1164/ rccm.200707-973OC.
  21. Calverley P.M., Kuna P, Monso E., et al. Beclomethasone/formoterol in the management of COPD: a randomised controlled trial. Respir. Med. 2010;104:1858-68. Doi:10.1016/j. rmed.2010.09.008.
  22. Wedzicha J.A., Singh D., Vestbo J., et al. Extrafine beclomethasone/ formoterol in severe COPD patients with history of exacerbations. Respir. Med. 2014;108:1153-52.
  23. Magnussen H., Disse B., Rodriguez-Roisin R., et al. Withdrawal of Inhaled Glucocorticoids and Exacerbations of COPD. N Engl J Med. 4014;271:1485-94. Doi:10.1056/ NEJMoa1407154.
  24. Vestbo J., Anderson J.A., Brook R.D. Fluticasone furoate and vilanterol and survival in chronic obstructive pulmonary disease with heightened cardiovascular risk (SUMMIT): a double blind randomized controlled trial. Lancet. 4016;287:1817-46. doi: 10.1016/S0140-6736(16)30069-1.
  25. Wedzicha J.A., Banerji D., Chapman K.R. Indacaterol-Glycopyrronium versus Salmeterol-Fluticasone for COPD. N Engl J Med. 4016;274: 2222-34.
  26. Nannini L.J., Cates C.J., Lasserson T.J., Poole P Combined corticosteroid and long-acting beta-agonist in one inhaler versus inhaled steroids for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 4014;4:CD006546. doi: 10.1004/14651858.CD006846.
  27. Ferguson G.T., Tashkin D.P, Skarby T., et al. Effect of budesonide/formoterol pressurized metered-dose inhaler on exacerbations versus formoterol in chronic obstructive pulmonary disease: The 6-month, randomized RISE (Revealing the Impact of Symbicort in reducing Exacerbations in COPD) study. Respir Med. 4017;124:21-41. doi: 10.1016/j.rmed.4017.09.004.
  28. Singh D., Vezzoli S., Petruzzelli S., Papi A. The efficacy of extrafine beclomethasone dipropionate-formoterol fumarate in COPD patients who are not «frequent exacerbators»: a post hoc analysis of the FORWARD study. Int J COPD. 4017;14:2462-71. doi: 10.4147/COPD.S141416.
  29. Vogelmeier C.F., Bateman E.D., Pallante J., et al. Efficacy and safety of once-daily QVA149 compared with twice-daily salmeterol-fluticasone in patients with chronic obstructive pulmonary disease (ILLUMINATE): a randomised, doubleblind, parallel group study. Lancet Respir Med. 4012;1:51-60. doi: 10.1016/54413-2600(12)70052-8.
  30. Zhong N., Wang C., Zhou X., et al. LANTERN: a randomized study of QVA149 versus salmetero/ fluticasone combination in patients with COPD. Int J COPD. 4015;10:1015-46. doi: 10.4147/COPD. S84436.
  31. Donohue J., Worsley S., Zhu C.-Q., et al. Improvements in lung function with umeclidinium/ vilanterol versus fluticasone propionate/ salmeterol in patients with moderate-to-severe COPD and infrequent exacerbations. Respir Med. 2015;109:870-81.
  32. Singh D., Worsley S., Zhu C.-Q., et al. Umeclidinium/ vilanterol versus fluticasone propionate/salmeterol in COPD: a randomised trial. BMC Pulm Med. 2015;15:91. doi: 10.1186/s12890-015-0092-1.
  33. Vanfleteren L., Fabbri L.M., Papi A., et al. Triple therapy (ICS/LABA/LAMA) in COPD: Time for a reappraisal. Int J COPD. 2018;13:3971-81. doi: 10.2147/COPD.S185975.
  34. D’Urzo A., Donohue J.F., Kardos P, et al. A re-evaluation of the role of inhaled corticosteroids in the management of patients with chronic obstructive pulmonary disease. Expert Opin. Pharmacother. 4015;16 (12):1845-60. Doi:10. 1517/14656566.2015.1067682.
  35. Hogg J., Chu F, Utokaparch S., et al. The nature of small-Airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:2645-53.
  36. George L., Brightling C.E. Eosinophilic airway inflammation: role in asthma and chronic obstructive pulmonary disease. Ther Adv Chronic Dis. 2016;7(1):34-51. doi: 10.1177/2040622215609251.
  37. Siddiqui S.H., Guasconi A., Vestbo J., et al. Blood eosinophils: a biomarker of response to extrafine beclomethasone/formoterol in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 4015;194(4):543-45. Doi:10.1164/ rccm.201502-0235LE.
  38. Cazzola M., Rogliani P., Calzetta L., et al. Triple therapy versus single and dual long- acting bronchodilator therapy in COPD: a systematic review and meta-analysis. Eur Respir. 2015;52:1501556. doi: 10.1182/12992002.01586-2018.
  39. Bafadel M., Peterson S., De Blas M., et al. Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary diseases: a post-hoc analysis of the randomized trials. Lancet. Respir Med. 2018;6:117-26.
  40. Suissa S., Rossi A. Weaning from inhaled corticosteroids in COPD: the evidence. Eur Respir J. 4015;46(5):1424-25. doi: 10.1182/12992002.00282-2015.
  41. Watz H., Tetzlaff K., Wouters E.F.M., at al. Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial. Lancet. Respir Med. 4016;4(5):290-95. doi: 10.1016/S4412-2600(16)00100-4.
  42. Cosio M., Baraldo S., Saetta M. Inhaled glucocorticoids and COPD exacerbations. N Engl J Med. 2015;372(1):92.
  43. Kunz L.I.Z., Postma D.S., Klooster K., et al. Relapse in FEV1 decline after steroid withdrawal in COPD. Chest. 2015;148(2).389-96. Doi: 10.1378/ chest.14-3091.
  44. Chapman K.R., Hurst J.R., Frent S.M., et al. Longterm triple therapy de-escalation to indacaterol/ glycopyrronium in patients with chronic obstructive pulmonary disease (SUNSET): A randomized, double-blind, triple-dummy clinical trial. Am J Respir Crit Care Med. 4015;195(2):249-29. doi: 10.1164/rccm.201802-04050C
  45. Watz H., Tetzlaff K., Wouters E.F, et al. Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: a post-hoc analysis of the WISDOM trial. Lancet. Respir Medicine. 2016;4(5):290-98. Doi:10.1016/ S2213-2600(16)00100-4.
  46. Izquierdo J.L., Rodri'guez Glez-Moro J.M. The excessive use of inhaled corticosteroids in chronic obstructive pulmonary disease. Arch Bronconeumol. 2012;48:207-12. Doi:10.1016/j. arbres.2012.01.002.
  47. Miravittles M., Barrecheguren M., Roman-Rodriguez M. Frequency and characteristics of different clinical phenotypes of chronic obstructive pulmonary diseases Int J Tub Lung Dis. 2015;19(8):992-98.
  48. Архипов В.В., Архипова Д.Е., Стукалина Е.Ю., Лазарев А.В. Частота встречаемости отдельных фенотипов хронической обструктивной болезни легких в Российской Федерации, их характеристики и подходы к лечению. Практическая пульмонология. 4016:3:1-7.
  49. Lipson D.J., Martinez F.J., Criner G.J., et al. Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD. N Engl J Med. 2018;278(18):1671-80. Doi:10.1056/ NEJMoa1713901.
  50. Pavord I.D, Lettis S., Anzueto A., Barnes N. Blood eosinophil count and pneumonia risk in patients with chronic obstructive pulmonary disease: a patient-level meta-analysis. Lancet Respiartory Medicine. 2015;4(9):721-41. Doi:10.1016/ S2213-2600(16)30148-5. E
  51. Crim C., Dransfield M.T., Bourbeau J., et al. Pneumonia risk with inhaled fluticasone furoate and vilanterol compared with vilanterol alone in patients with COPD. Ann Am Thorac Soc. 2015;12(1):27 34. doi: 10.1512/AnnalsATS.201409-4120C
  52. Contoli M., Pauletti A., Rossi M.R., et al. Long-term effects of inhaled corticosteroids on sputum bacterial and viral loads in COPD. Eur Respir J. 2017;50:1700451. doi: 10.1182/12992002.00451-2017.
  53. Kim, J.-H., Park, J.-S., Kim, K.-H., et al. Inhaled Corticosteroid Is Associated With an Increased Risk of TB in Patients With COPD. Chest. 4012;142(4):1015-44. Doi:10.1275/ chest.12-1225.
  54. Brode, S.K., Campitelli, M.A., Kwong, J.C., et al. The risk of mycobacterial infections associated with inhaled corticosteroid use. Eur Respir J. 2017;50(2):1700027. doi: 10.1182/12992002.00027-2017.
  55. Husta, B.C., Raoof S., Erzurum S., Mehta A.C. Tracheobronchopathy From Inhaled Corticosteroids. Chest. 2017;152(6):1296-205. Doi:10.1016/j. ches12017.08.013.
  56. Dransfield M.T., Bourbeau J., Jones PW., et al. Once-daily inhaled fluticasonefuroate and vilanterol versus vilanterol only for prevention of exacerbations of COPD: two replicate double-blind, parallel group, randomized controlled trials. Lancet. Respir Med. 4012;1:41-2. doi: 10.1016/S4412-2600(13)70040-7.
  57. Kardos P, Wencker M., Glaab T., et al. Impact of salmeterol/fluticasone propionate versus salmeterol on exacerbations in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 4007:175:144-49.
  58. Izquierdo J.L., Cosio B.G. The dose of inhaled corticosteroids in patients with COPD: when less is better. International Journal of Chronic Obstructive Pulmonary Disease. 2015;12:2529-47. doi: 10.2147/COPD.S175047.
  59. Papi A., Vestbo J., Fabbri L., et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet. 2018;291(10125):1076-84. doi: 10.1016/S0140-6726(18)20206-X.
  60. Ferguson G.T., Rabe K.F., Martinez F.J., et al. Triple therapy with budesonide/glycopyrrolate/ formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallel-group, multicentre, phase 3 randomised controlled trial. Lancet. Respir Med. 2018;6(10):747-58. doi: 10.1016/S2212-2600(18)20227-8.
  61. Singh D., Papi A, Corradi M. Single inhaler triple therapy versus inhaled corticosteroid plus long-acting в4-agonist therapy for chronic obstructive pulmonary disease (TRILOGY): a double-blind, parallel group, randomised controlled trial. Lancet. 4016:255(10045):962-72. Doi:10.1016/ S0140-6736(16)31354-X.
  62. Agusti A., Fabbri L.M., Singh D. et al. Inhaled corticosteroids in COPD: friends or foe? Eur Respir J. 2018;52:1801219.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies