Potential Benefits of Down Titration Through Inhaled Steroid Discontinuation

SOURCE: Suissa S, et al. Discontinuation of inhaled corticosteroids in COPD and the risk reduction of pneumonia. Chest 2015;148:1177-1183.

Treatment for moderate to severe chronic obstructive pulmonary disease typically includes in addition to anticholinergics, the use of long-acting beta-agonists and inhaled corticosteroids (ICS). Long-acting beta-agonists and ICSs tend to be administered in combination through a single inhalation device. Nearly 90% of all patients suffering from COPD are prescribed an ICS, despite many not meeting the required thresholds for treatment outlined by the FDA. Recent data has suggested that COPD patients taking ICSs may be more susceptible to contracting pneumonia—prompting the 5-year investigative study by Suissa et al. Utilizing the Quebec health insurance database, Suissa et al analyzed the population of COPD patients prescribed ICS by comparing incidences of pneumonia in patients who discontinued ICS with those who continued ICS treatment.

The study’s findings revealed a 37% decrease in the likelihood of pneumonia contraction in the group that did not continue taking inhaled corticosteroids, and this reduction was demonstrated as quickly as within the first month of the study. There was significant variation among ICS treatments in the risk presented for pneumonia reduction, but the cessation of each ICS proved to reduce pneumonia risk. Suissa et al implicate an over-prescription of ICS as a potential cause for rises in pneumonia cases post-treatment, and suggest that restricting use of ICS’s could decrease the potential for pneumonia while not lessening the efficacy of medical care.