Patients with the lung disease COPD receive medications to improve breathing ability combined with corticosteroids, which reduce the risk of acute lung deterioration. The balance between this reduction and the increase in harmful side effects depends on dosage and patient characteristics, as researchers at the University of Zurich have now shown. Thanks to the findings, COPD sufferers can be treated more specifically.
Patients with chronic obstructive pulmonary disease (COPD) suffer from permanent narrowing of the airways, which makes breathing difficult. The narrowing is caused by inflammation of the small airways, which leads to mucus production and destroys lung tissue. Inhaled corticosteroids are usually used in combination with long-acting bronchodilators to prevent acute worsening of the lung condition in COPD patients. While corticosteroids reduce inflammation or worsening of the condition, bronchodilators improve breathing by dilating the bronchi.
Benefit of corticosteroids depends on three main factors
The use of corticosteroids in the very heterogeneous group of COPD patients has been debated for years. Although guidelines suggest a personalized treatment approach. But these remain quite vague, as it is unclear for whom the benefits outweigh the harmful side effects. A study led by Henock Yebyo, a postdoctoral researcher at the Institute of Epidemiology, Biostatistics and Prevention at the University of Zurich (UZH), now sheds light on this question. “Our results show that three main factors influence the balance between treatment benefits and side effects of different doses of corticosteroids: the risk of acute exacerbation, the amount of certain blood cells, and the patient’s age,” said first author Yebyo.
Systematic consideration of treatment and patient characteristics
The researchers considered numerous characteristics of therapies and patients that have an impact on the risk-benefit ratio. They performed extensive statistical analyses to calculate how high the risk of acute exacerbations would have to be in patients for the benefits of reducing that risk to outweigh the side effects: severe pneumonia, fungal infection of the oral mucosa, and hoarseness. They found that patients do not benefit from low-to-moderate-dose corticosteroids if their risk of experiencing an acute exacerbation in the next two years is less than 32 percent. Which is typically those patients whose lung condition has been stable in the past.
Guidelines have not yet addressed corticosteroid dosing. The UZH study now clearly shows that high doses are associated with significant side effects that do not justify the benefits. Patients over 80 years of age are also unlikely to benefit from therapy because their risk of developing pneumonia is higher than the reduction in acute exacerbation. In contrast, patients with larger amounts of certain blood cells typical for asthma – so-called eosinophils – are more likely to benefit.
Systematic approach enables more individualized treatments
When the researchers reviewed their findings using data from two groups of patients from Switzerland and the Netherlands, they found that some patients are overtreated with corticosteroids while others are undertreated. “Our results do not necessarily lead to less corticosteroid use. But they do help minimize overuse and underuse by tailoring therapy in terms of dosage and patient characteristics,” explains Henock Yebyo.
Source:
Yebyo HG, Braun J, Menges D, Riet Gt, Sadatsafavi M, Puhan MA. Personalising add-on treatment with inhaled corticosteroids in patients with chronic obstructive pulmonary disease: a benefit-harm modelling study. Lancet Digital Health. 25 August 2021. DOI: 10.1016/S2589-7500(21)00130-8
