Withdrawal of inhaled corticosteroids in COPD: a European Respiratory Society guideline.

Inhaled corticosteroids (ICS) combined with bronchodilators can reduce the frequency of exacerbations in some patients with chronic obstructive pulmonary disease (COPD). There is evidence, however, that ICS are frequently used in patients where their benefit has not been established. Therefore, there is a need for a personalised approach to the use of ICS in COPD and to consider withdrawal of ICS in patients without a clear indication. This document reports European Respiratory Society recommendations regarding ICS withdrawal in patients with COPD.Comprehensive evidence synthesis was performed to summarise all available evidence relevant to the question: should ICS be withdrawn in patients with COPD? The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence synthesis was discussed and recommendations formulated by a committee with expertise in COPD and guideline methodology.After considering the balance of desirable and undesirable consequences, quality of evidence, and feasibility and acceptability of interventions, the guideline panel made: 1) conditional recommendation for the withdrawal of ICS in patients with COPD without a history of frequent exacerbations, 2) strong recommendation not to withdraw ICS in patients with blood eosinophil counts ≥300 eosinophils·µL

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Copyright ©ERS 2020.

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Conflict of interest: J.D. Chalmers has received speaker fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Insmed; consultancy fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Grifols, Insmed and Zambon; and holds research grants from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Gilead Sciences Grifols and Novartis. Conflict of interest: I.F. Laska has nothing to disclose. Conflict of interest: F.M.E. Franssen reports research grants from AstraZeneca and Novartis and fees for consultancy from Boehringer Ingelheim, Chiesi, GSK and Teva. Conflict of interest: W. Janssens reports grants, speakers’ and consultancy fees from Chiesi, AstraZeneca, Boehringer and GSK, outside the submitted work. Conflict of interest: I. Pavord reports fees for consultancy from AstraZeneca, Boehringer Ingelheim, Aerocrine, Almirall, Novartis, GSK, Genentech, Regeneron, Teva, Chiesi, Sanofi, Cricassia, and Knopp, grants from the National Institute for Health Research. Conflict of interest: D. Rigau is methodologist of the European Respiratory Society. Conflict of interest: M.J. McDonnell reports personal fees from Boehringer Ingelheim and Menarini, grants from Health Research Board Ireland, outside the submitted work. Conflict of interest: N. Roche reports grants and personal fees from Boehringer Ingelheim, Novartis and Pfizer, and personal fees from Teva, GSK, AstraZeneca, Chiesi, Mundipharma, Cipla, Sanofi, Sandoz, 3M, Trudell and Zambon. Conflict of interest: D.D. Sin has received research funding from AstraZeneca and Merck, has received honoraria for speaking engagements from Novartis, Boehringer Ingelheim and AstraZeneca, and fees for advisory board work from Sanofi-Aventis and Regeneron. Conflict of interest: D. Stolz reports research grants from AstraZeneca, Curetis and Boston Scientific, and fees for consultancy from AstraZeneca, Novartis, GSK, Roche, Zambon, Pfizer and Schwabe Pharma. Conflict of interest: S. Suissa reports grants and personal fees from Novartis and Boehringer Ingelheim, and personal fees from AstraZeneca, outside the submitted work. Conflict of interest: J. Wedzicha has received research grants from GlaxoSmithKline, Boehringer Ingelheim, Novartis, AstraZeneca, Chiesi and Johnson & Johnson. D. Stolz reports research grants from AstraZeneca, Curetis and Boston Scientific, and fees for consultancy from AstraZeneca, Novartis, GSK, Roche, Zambon, Pfizer and Schwabe Pharma. Conflict of interest: M. Miravitlles has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Sandoz, Zambon, CSL Behring, Grifols and Novartis, consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, Kamada, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, Teva, pH Pharma, Novartis, Sanofi and Grifols, and research grants from GlaxoSmithKline and Grifols.