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Discontinuing ICS therapy in COPD hastens decline in lung function

Lung function decline quickened during a 5-year follow-up in patients with moderate to severe COPD who ceased use of or sporadically maintained inhaled corticosteroid treatment after 30 months of therapy, according to study results.

“This study shows that discontinuation of inhaled corticosteroid (ICS) after long-term use in COPD seems to accelerate lung function decline during subsequent follow-up together with deterioration in airway hyperresponsiveness (AHR) and health-related quality of life (QOL),” Lisette I.Z. Kunz, MD, of Leiden University Medical Center in the Netherlands, and colleagues wrote. “This indicates that the initial benefits of 30-month ICS treatment on COPD progression are confined to active treatment and are not sustained after long-term cessation of ICS.”

Researchers conducted a two-part study to determine the extent of decline in forced expiratory volume in 1 second (FEV₁) in patients who stopped ICS therapy.

The first part of the study included a double blind, placebo-controlled trial of 86 participants with moderate to severe COPD. Participants were randomly assigned to one of several twice-daily, dry-powder inhalants. Treatments were either 6 months or 30 months of fluticasone propionate 500 µg, 30 months of fluticasone with salmeterol 500/50 µg, or 30 months of placebo.

Participants visited the outpatient clinic annually for 5 consecutive years after the 30-month trial.

Yearly decline in FEV₁ was faster during the second phase of the study when compared with the first in patients who used ICS no more than 50% of the time (n = 56) in the group assigned fluticasone/salmeterol (–68 mL/year; 95% CI, –112 to –25 mL/year) and fluticasone (–73 mL/year; 95% CI, –119 to –26 mL/year). Declines also were observed in AHR and QOL.

Participants who did not use ICS during the second phase (n = 34) experienced an even greater decline in FEV₁ for both the fluticasone/salmeterol (–106 mL/year; 95% CI, –171 to –41 mL/year) and fluticasone groups (–84 mL/year; 95% CI, –149 to –18 mL/year).

“Though these data may suggest that ICS treatment in COPD should not be discontinued, this study was not designed to show evidence of any continued benefits of prolonged ICS therapy,” the researchers wrote. –by Ryan McDonald

Disclosure: Kunz reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.