Pulmonologists' Opinion on the Use of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease Patients in Spain: A Cross-Sectional Survey.

Identifying the variables that guide decision-making in relation to the use of inhaled corticosteroids (ICS) can contribute to the appropriate use of these drugs. The objective of this study was to identify the clinical variables that physicians consider most relevant for prescribing or withdrawing ICS in COPD. A cross-sectional survey was conducted in Spain from November 2020 to May 2021. Therapeutic decisions on the use of ICS in 11 hypothetical COPD patient profiles were collected using an online survey answered by specialists with experience in the management of patients with COPD. Mixed-effects logistic regression was used to analyze the impact of patients' characteristics in the therapeutic decision for prescribing ICS or proceeding to its withdrawal. A total of 74 pulmonologists agreed to collaborate in the survey and answered the questionnaire. The results showed great variability, with only 2 profiles achieving consensus for starting or withdrawing the treatment. The frequency and severity of exacerbations influenced the decision to prescribe ICS in a dose-response fashion (1 exacerbation odds ratio (OR) = 1.86, 95% confidence interval (CI) 1.02 to 3.43, two exacerbations OR = 11.6, 95% CI: 4.47 to 30.2 and three OR = 123, 95% CI: 25 to 601). Similarly, increasing blood eosinophils and history of asthma were associated with ICS use. On the other hand, pneumonia reduced the probability of initiating treatment with ICS (OR = 0.54 [0.29 to 0.98]). Lung function and dyspnea degree did not influence the clinician's therapeutic decision. The results for withdrawal of ICS were similar but in the opposite direction. In accordance with guidelines, exacerbations, blood eosinophils and history of asthma or pneumonia are the factors considered by pulmonologist for the indication or withdrawal of ICS. However, the agreement in prescription or withdrawal of ICS when confronted with hypothetical cases is very low, suggesting a great variability in clinical practice.

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© 2022 Miravitlles et al.

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The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE). The authors did not receive payment related to the development of the manuscript. MM has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, Menarini, Rovi, Bial, Sandoz, Zambon, Kamada, CSL Behring, Grifols and Novartis, consulting fees from AstraZeneca, Atriva Therapeutics, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Bial, Gebro Pharma, CSL Behring, Laboratorios Esteve, Ferrer, Mereo Biopharma, Verona Pharma, Spin Therapeutics, ONO Pharma, pH Pharma, Palobiofarma SL, Takeda, Novartis, Sanofi and Grifols and research grants from Grifols. FG has received economic compensation for consulting, lectures at various congresses and scientific training sessions, manuscript writing and support for attending meetings from Boehringer Ingelheim, GSK, Novartis, Astrazeneca, Chiesi, Pfizer, Esteve and Rovi. CRR reports no disclosure related to this paper. XP has received speaker fees from Boehringer Ingelheim, GlaxoSmithKline, Rovi and Chiesi. EMM has received economic compensation for consulting, lectures, presentations, manuscript writing, educational events, support for attending meetings, participation in data safety monitoring or advisory board from Boehringer Ingelheim, Glaxo Smith Kline, Novartis, Aflofarm, Bial, Chiesi, Meranini and GSK. CG has received economic compensation for consulting, support for attending meetings from Chiesi, Boehringer Ingelheim, Glaxo Smith Kline, Novartis, Meranini, Ferrer and Teva. CA has received speaker fees and/or consulting fees from Boehringer Ingelheim, Pfizer, AstraZeneca, Novartis, Chiesi, Faes farma, Esteve and GlaxoSmithKline. CF has received economic compensation by GOC Health Consulting for statistical analysis. SA has received economic compensation for support for attending meetings, other sessions and consulting from Novartis, Astra Zeneca, Menarini, GSK, Boeringer Ingelheim, Chiesi, Mundipharma, FAES, Pfizer and Teva. BA reports personal fees from GSK, grants, personal fees and non-financial support from Novartis, personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from Chiesi, grants, personal fees and non-financial support from Laboratorios BIAL, Menarini, personal fees from Gebro, Astra- Zeneca, and Gilead, outside the submitted work. In addition, has a patent P201730724 pending. EN has received economic compensation for consulting, lectures, presentations, manuscript writing and educational events from Novartis, Boehringer Ingelheim, Chiesi and Glaxo Smith Kline. MB reports personal fees from Grifols, Menarini, CSL Behring, GSK, Boehringer Ingelheim, and Novartis, outside the submitted work. The authors report no other conflicts of interest in this work.