Pros and Cons of Inhaled Corticosteroids Withdrawal in Chronic Obstructive Pulmonary Disease

Inhaled corticosteroids (ICS) are widely prescribed in chronic obstructive pulmonary disease (COPD) regardless of any guidance recommendation and of any stage of disease severity, either in fixed dose combination with a long-acting β2-adrenergic agonist (LABA) or as a component of a triple therapy combination of different inhalers. However, the benefits of ICS in COPD are controversial. There is no recommendation for ICS in Global Initiative for Chronic Obstructive Lung Disease (GOLD) “low-risk” of exarcerbation patients and there are also limitations for those patients at “high-risk”. Due to potential severe adverse effects, ICS should be discontinued in patients who do not need them. The safe withdrawal of ICS in COPD constitutes the main thrust of this article. We believe that ICS can be safely withdrawn in patients at low-risk. For patients at high risk of exacerbation, ICS may be discontinued with caution, monitoring changes in forced expiratory volume in one second (FEV1) and in peripheral blood eosinophils. In all COPD patients, maintenance therapy with long-acting bronchodilators must be in place.