Inhaled Corticosteroids Prescribed for COPD Patients with Mild or Moderate Airflow Limitation: Who Warrants a Trial of Withdrawal?

Timothy H Harries,1 Gill Gilworth,1 Christopher J Corrigan,2 Patrick B Murphy,3 Nicholas Hart,3 Mike Thomas,4 Patrick T White1 1Department of Public Health and Primary Care, School of Population Health and Environmental Sciences, King’s College London, London, UK; 2Department of Asthma Allergy and Respiratory Science, King’s College London, London, UK; 3Lane Fox Respiratory Unit, Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, London, UK; 4Primary Care and Population Medicine, University of Southampton, Southampton, UKCorrespondence: Timothy H HarriesDepartment of Public Health and Primary Care, School of Population Health and Environmental Sciences, King’s College London 3rd Floor Addison House, Guys Campus, London SE1 1UL, UKTel +44 20 7836 5454Email timothy.harries@kcl.ac.ukAbstract: COPD patients prescribed inhaled corticosteroids (ICS) outside guidelines should be targeted for ICS withdrawal. Within a primary care population of 209,618 we used a combination of digital search algorithm, individual record review, and clinical review to identify COPD patients suitable for a trial of ICS withdrawal. At most, 39% of COPD patients with mild or moderate airflow limitation prescribed ICS were suitable for withdrawal according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Recurrent exacerbations and reversible airway obstruction were the main reasons for patients’ unsuitability for withdrawal. Identifying COPD patients in whom ICS withdrawal should be considered presents a challenge to primary care clinicians.Keywords: pulmonary disease, chronic obstructive, inhaled corticosteroids, drug withdrawal, mild airflow limitation, moderate airflow limitation