Pragmatic trial on inhaled corticosteroid withdrawal in patients with COPD in general practice

Autor: Martina Teichert, Tjard Schermer, Michel Wensing, Anne Rutjes, Victor van der Meer, Gerben Stege, Lisette van den Bemt, Lotte van den Nieuwenhof
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Exacerbation
medicine.drug_class
Health Status
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Therapeutics
Article
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Pulmonary Disease
Chronic Obstructive
All institutes and research themes of the Radboud University Medical Center
Adrenal Cortex Hormones
Internal medicine
Bronchodilator
Administration
Inhalation
medicine
Humans
In patient
Aged
lcsh:RC705-779
COPD
business.industry
Chronic obstructive pulmonary disease
Public Health
Environmental and Occupational Health
Severe exacerbation
lcsh:Diseases of the respiratory system
medicine.disease
Pragmatic trial
Clinical trial design
Bronchodilator Agents
Dyspnea
Withholding Treatment
General practice
Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5]
Quality of Life
Corticosteroid
Female
business
Zdroj: npj Primary Care Respiratory Medicine, 30(1). NATURE RESEARCH
npj Primary Care Respiratory Medicine, Vol 30, Iss 1, Pp 1-8 (2020)
NPJ Primary Care Respiratory Medicine
Npj Primary Care Respiratory Medicine, 30, 1
Npj Primary Care Respiratory Medicine, 30
ISSN: 2055-1010
Popis: The therapeutic value of inhaled corticosteroids (ICSs) for COPD is limited. In published RCTs, ICS could be withdrawn in COPD patients without increasing exacerbation risk when bronchodilator treatment is optimized. Here we report on the feasibility and risks of ICS withdrawal in Dutch general practice for COPD patients without an indication for ICSs. In our pragmatic trial, general practitioners decided autonomously which of their COPD patients on ICS treatment could stop this, how this was done, and whether additional bronchodilator therapy was needed. We recruited 62 COPD patients (58 analysed) who were eligible for ICS withdrawal in 79 practices. In 32 patients (55.2%, 95% CI: 42.5–67.3%) ICS was withdrawn successfully, 19 (32.8%, 95% CI: 22.1–45.6%) restarted ICS treatment within six months, 12 patients (20.7%, 95% CI: 12.3–32.8%) had a moderate exacerbation, and one patient had a severe exacerbation. ICS withdrawal was successful in just over half of the patients with COPD without an indication for ICS.
Databáze: OpenAIRE
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