This inflammation includes both the innate and adaptive immune system and many kinds of cells such as neutrophils, macrophages and lymphocytes. The underlying cause for the lung impairment in COPD is airway inflammation and destructive structural changes ( 9). In the BOLD study, half of those diagnosed as having COPD did not fulfil the spirometric criteria for the disease ( 8). A problem, however, is that 80% of these individuals have not been diagnosed ( 7).
The Burden of Obstructive Lung Disease (BOLD) study showed that globally 10–20% of the population that are 40 years or older have a spirometry that fulfils this criterion for COPD ( 6).
In the GOLD guidelines, airflow obstruction is defined as a ratio between forced expiratory volume in one second (FEV 1) and forced vital capacity (FVC) that is below 0.7 after bronchodilation ( 5). COPD is globally the third leading cause of mortality ( 3) and in Sweden it has been estimated that COPD patients on average live 8 years shorter than aged matched persons without COPD ( 4).ĬOPD is characterised by chronic airflow obstruction. Accepted for publication Feb 13, 2020.Ĭhronic obstructive pulmonary disease (COPD) is a common disorder, which has a large negative effect on health-related quality of life ( 1) and causes a large burden for the individual patient and the society as a whole ( 2). Keywords: Chronic obstructive pulmonary disease (COPD) inhaled corticosteroids (ICSs) eosinophils There are data indicating that the choice of ICS matters, with studies showing a better effect-safety profile with budesonide compared to fluticasone propionate whereas it is not possible to make benefit-risk comparisons between the other licensed ICSs.
The indication of using ICS in COPD is stronger if the patient has increased blood eosinophils levels. In conclusion, ICS together with LABA or LABA/LAMA reduces the risk of exacerbations in COPD. Studies comparing the effect and safety of other ICSs such as fluticasone furoate and beclomethasone are too few to draw firm conclusions from. There are four observational studies showing a better effect on exacerbations with budesonide/formoterol than fluticasone propionate/salmeterol and three observational studies showing less risk of pneumonia with budesonide than fluticasone propionate. There is also data indicating that ICS has a small but significant positive effect on lung function decline and decrease mortality. Several investigations have shown that the number of eosinophils in blood predicts whether a patient will benefit from treatment with ICS. Studies comparing the effect of ICS/LABA and LABA/LAMA on exacerbations have shown divergent results, whereas most studies comparing ICS/LABA/LAMA (triple therapy) with LABA/LAMA have reported fewer exacerbations with triple therapy. The aim of this review was to investigate when to use ICS in COPD and to compare the effectiveness and safety of different ICSs.
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Treatment with ICS is, however, associated with side effects such as oropharyngeal candidiasis, skin thinning or easy bruising and pneumonia.
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