Iowa city, IA—Inhaled corticosteroids (ICSs) combined with bronchodilators are used to improve outcomes in chronic obstructive pulmonary disease (COPD) even though their use can lead to certain adverse effects.

Confusing the matter is that no consensus on the optimal ICS dosing regimen has been reached, according to a new study in the International Journal of Chronic Obstructive Pulmonary Disease.

The researchers associated with the University of Iowa and colleagues performed a systematic review and meta-analysis to try to clarify the efficacy and safety of dosing levels—high versus medium/low—of ICS with ancillary bronchodilators and in line with PRISMA guidelines.

The researchers systematically searched Medline and Embase until December 2021, including randomized, clinical trials (RCTs) that met predefined criteria. The trials included risk ratios (RRs) with 95% CIs.

“Any acute exacerbation of COPD (AECOPD) risk was chosen as the primary efficacy outcome, mortality rate as the primary safety outcome, moderate/severe AECOPD risk as the secondary efficacy outcome and pneumonia risk as the secondary safety outcome,” the authors explained, adding, “Subgroup analyses of individual ICS agents, of patients with baseline moderate/severe/very severe COPD and of patients with recent COPD exacerbation history were also performed. A random-effects model was used.”

Ultimately, 13 RCTs were included in the study, although no data on low doses were included in the analysis.

The results indicated that high-dose ICS was not associated with a statistically significant difference in any AECOPD risk (RR 0.98; 95% CI, 0.91-1.05, I2: 41.3%), mortality rate (RR 0.99; 95% CI, 0.75-1.32, I2: 0%), moderate/severe AECOPD risk (RR 1.01; 95% CI, 0.96-1.06, I2: 0%), or pneumonia risk (RR 1.07; 95% CI, 0.86-1.33, I2: 9.3%) compared with medium-dose ICS. The authors pointed out that the same trend was identified with several subgroup analyses.

“Our study collected RCTs investigating the optimal dosing level of ICS prescribed alongside ancillary bronchodilators to patients with COPD,” the researchers concluded. “We identified that the high ICS dose neither reduces AECOPD risk and mortality rates nor increases pneumonia risk relative to the medium dose.”

Global Initiative for Chronic Obstructive Lung Disease guidelines have consistently recommended a stepwise approach to the pharmacologic management of COPD in its stable state, using different inhaled medication classes, according to background information in the article.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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