Withdrawal of inhaled corticosteroids in COPD: a European Respiratory Society guideline
Withdrawal of inhaled corticosteroids in COPD: a European Respiratory Society guideline
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DOI：
10.1183/13993003.00351-2020
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发表时间：
2020-06-01
影响因子：
24.3
通讯作者：
Miravitlles, Marc
中科院分区：
文献类型：
--
作者：
Chalmers, James D.;Laska, Irena F.;Miravitlles, Marc
吸入皮质类固醇（ICS）联合支气管扩张剂可以减少一些慢性阻塞性肺疾病（COPD）患者的急性发作频率。然而，有证据表明，ICS经常用于尚未确定其益处的患者。因此，有必要对慢性阻塞性肺病患者使用ICS采取个性化的方法，并考虑在没有明确适应症的患者中停用ICS。本文件报告了欧洲呼吸学会关于慢性阻塞性肺病患者停药的建议。我们进行了全面的证据综合，总结了所有与以下问题相关的现有证据：COPD患者是否应该停用ICS ？使用GRADE（建议、评估、发展和评价分级）方法对证据进行评价，并在证据概要中总结结果。对证据综合进行了讨论，并由COPD专家委员会和指南方法学制定了建议。在权衡了理想和不良后果、证据质量以及干预措施的可行性和可接受性后，指南小组提出：1)有条件建议无频繁加重史的COPD患者停用ICS； 2)强烈建议有嗜酸性粒细胞计数的患者不停用ICS。300嗜酸性粒细胞。如果停药，强烈建议使用一种或两种长效支气管扩张剂。有条件的建议表明，干预的理想和不理想的后果之间的平衡存在不确定性，知情的患者可能会对是否进行特定的干预做出不同的选择。
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evidence synthesis was performed to summarise all available evidence relevant to the question: should ICS be withdrawn in patients with COPD?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eosinophils.mu L-1 and 3) strong recommendation to treat with one or two long-acting bronchodilators if ICS are withdrawn.A conditional recommendation indicates that there was uncertainty about the balance of desirable and undesirable consequences of the intervention, and that well-informed patients may make different choices regarding whether to have or not have the specific intervention.