The use of inhaled corticosteroids for patients with COPD who continue to smoke cigarettes: an evaluation of current practice
Author(s)
Adcock, IM
Bhatt, SP
Balkissoon, R
Wise, RA
Type
Journal Article
Abstract
The use of inhaled corticosteroids (ICS) in combination with inhaled bronchodilators for patients with chronic obstructive pulmonary disease (COPD) is a common practice in primary care settings. However, ICS-containing therapies may be less effective in patients with COPD compared with asthma, and in individuals with COPD who continue to smoke cigarettes. Preclinical studies suggest that inflammation in COPD is very different from in asthma. Glucocorticoid receptor functioning and other innate anti-inflammatory mechanisms are altered in cells exposed to cigarette smoke. COPD may be relatively insensitive to ICS, especially in individuals who continue to smoke. ICS-containing therapies in patients with asthma who continue to smoke may also be less effective compared with patients who do not smoke. ICS-containing therapies may be inappropriately used in some patients with COPD, and their long-term use is associated with an increased risk for side effects, including pneumonia and bone fractures in some patients. Treatment for patients with COPD should be carefully evaluated, and anti-inflammatory/bronchodilatory strategies should be chosen based on individual patient characteristics and recommendations in current guidelines.
Date Issued
2022-03
Online Publication Date
2024-07-22T14:18:27Z
Date Acceptance
2021-10-01
ISSN
0002-9343
Publisher
Elsevier
Start Page
302
End Page
312
Journal / Book Title
American Journal of Medicine
Volume
135
Issue
3
Copyright Statement
© 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
Identifier
https://www.amjmed.com/article/S0002-9343(21)00641-0/fulltext
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000819807300023&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Publication Status
Published
Date Publish Online
2021-10-13