Recent trends in inhaled corticosteroid prescriptions and its impact on COPD management: an analysis of the KOLD/KOCOSS cohorts

Abstract

Background: This real-world cohort study was performed in chronic obstructive pulmonary disease (COPD) patients to evaluate the status of inhaled corticosteroid (ICS) prescriptions following the 2017 revision of the GOLD guidelines.

Methods: A total of 1144 patients from KOLD and KOCOSS cohorts, whose final follow-up visits were between 2017 and 2018, were analyzed. Features supporting ICS usage were: a history of asthma, blood eosinophils ≥300 cells/µl, or ≥2 exacerbations in the previous year. Among baseline ICS users, we compared annual total and severe exacerbation rates, based on ICS continuation or withdrawal.

Results: ICS-containing regimens were prescribed for 46.3% of patients at baseline; this decreased to 38.8% in 2017, and long-acting dual bronchodilators were widely used instead. Among ICS users in 2017, 47.5% did not exhibit features supporting ICS usage. ICS was withdrawn in 77 (16.1%) patients during the study period. Annual exacerbation rates were similar between ICS withdrawal and ICS continued groups (0.48 vs. 0.47, p=0.84); however, the ICS withdrawal group exhibited a significantly higher severe exacerbation rate (0.22 vs. 0.12, p=0.03). The proportion of patients with asthma and the baseline annual exacerbation rate were greater in the ICS withdrawal group than in the ICS continued group (56.6% vs. 41%, p=0.01; 0.79 vs. 0.53, p<0.001).

Conclusions: Prescriptions of ICS in COPD patients decreased with increased use of long-acting dual bronchodilators. ICS withdrawal might impact severe exacerbation; therefore it should be decided with consideration of potential risk and benefits of ICS based on patients’ characteristics.