Bernardino Alcázar Navarrete1, Ciro Casanova2, Marc Miravitlles3, Pilar de Lucas4, Juan Antonio Riesco5, José Miguel Rodríguez González-Moro4. 1. Neumología, Área integrada de gestión de Medicina, Hospital de Alta Resolución de Loja, APES Hospital de Poniente, Granada, España. Electronic address: balcazar@telefonica.net. 2. Servicio de Neumología, Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, España. 3. Servicio de Neumología, Hospital Universitari Vall d'Hebron, Barcelona, España. 4. Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Madrid, España. 5. Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, España.
Abstract
INTRODUCTION: Indications for inhaled corticosteroids (IC) in combination with long-acting bronchodilators (LABD) are well defined in clinical practice guidelines. However, there are some doubts about their efficacy and safety. The aim of this document is to establish an expert consensus to clarify these issues. METHOD: A coordinator group was formed, which systematically reviewed the scientific evidence with the aim of identifying areas of uncertainty about the efficacy of ICs, the adverse effects associated with their use and criteria for withdrawal. Their proposals were submitted to a panel of experts and the Delphi technique was used to test the level of consensus. RESULTS: Twenty-five experts participated in the panel, and consensus was reached on the use of IC in the mixed chronic obstructive pulmonary disease (COPD)-asthma phenotype and in frequent exacerbators, and on not using IC in association with LABD for improving lung function in COPD. There was no general consensus on restricting the use of IC to prevent adverse effects. The panel did agree that IC withdrawal is feasible but should be undertaken gradually, and patients who have discontinued must be evaluated in the short term. CONCLUSIONS: Consensus was reached regarding the indication of IC in mixed COPD-asthma and frequent exacerbator phenotypes. The potential for adverse effects must be taken into consideration, but there is no consensus on whether limiting use is justified. The withdrawal of ICs was uniformly agreed to be feasible.
INTRODUCTION: Indications for inhaled corticosteroids (IC) in combination with long-acting bronchodilators (LABD) are well defined in clinical practice guidelines. However, there are some doubts about their efficacy and safety. The aim of this document is to establish an expert consensus to clarify these issues. METHOD: A coordinator group was formed, which systematically reviewed the scientific evidence with the aim of identifying areas of uncertainty about the efficacy of ICs, the adverse effects associated with their use and criteria for withdrawal. Their proposals were submitted to a panel of experts and the Delphi technique was used to test the level of consensus. RESULTS: Twenty-five experts participated in the panel, and consensus was reached on the use of IC in the mixed chronic obstructive pulmonary disease (COPD)-asthma phenotype and in frequent exacerbators, and on not using IC in association with LABD for improving lung function in COPD. There was no general consensus on restricting the use of IC to prevent adverse effects. The panel did agree that IC withdrawal is feasible but should be undertaken gradually, and patients who have discontinued must be evaluated in the short term. CONCLUSIONS: Consensus was reached regarding the indication of IC in mixed COPD-asthma and frequent exacerbator phenotypes. The potential for adverse effects must be taken into consideration, but there is no consensus on whether limiting use is justified. The withdrawal of ICs was uniformly agreed to be feasible.
Authors: Jose L López-Campos; Maria Abad Arranz; Carmen Calero-Acuña; Fernando Romero-Valero; Ruth Ayerbe-García; Antonio Hidalgo-Molina; Ricardo I Aguilar-Pérez-Grovas; Francisco García-Gil; Francisco Casas-Maldonado; Laura Caballero-Ballesteros; María Sánchez-Palop; Dolores Pérez-Tejero; Alejandro Segado; Jose Calvo-Bonachera; Bárbara Hernández-Sierra; Adolfo Doménech; Macarena Arroyo-Varela; Francisco González-Vargas; Juan J Cruz-Rueda Journal: PLoS One Date: 2016-03-17 Impact factor: 3.240
Authors: Marc Miravitlles; Borja G Cosío; Aurelio Arnedillo; Myriam Calle; Bernardino Alcázar-Navarrete; Cruz González; Cristóbal Esteban; Juan Antonio Trigueros; José Miguel Rodríguez González-Moro; José Antonio Quintano Jiménez; Adolfo Baloira Journal: Respir Res Date: 2017-11-28
Authors: Jose Luis López-Campos; María Abad Arranz; Carmen Calero Acuña; Fernando Romero Valero; Ruth Ayerbe García; Antonio Hidalgo Molina; Ricardo I Aguilar Perez-Grovas; Francisco García Gil; Francisco Casas Maldonado; Laura Caballero Ballesteros; María Sánchez Palop; Dolores Pérez-Tejero; Alejandro Segado; Jose Calvo Bonachera; Bárbara Hernández Sierra; Adolfo Doménech; Macarena Arroyo Varela; Francisco González Vargas; Juan J Cruz Rueda Journal: Int J Chron Obstruct Pulmon Dis Date: 2016-06-02
Authors: Salud Santos; Alicia Marin; Joan Serra-Batlles; David de la Rosa; Ingrid Solanes; Xavier Pomares; Marta López-Sánchez; Mariana Muñoz-Esquerre; Marc Miravitlles Journal: Int J Chron Obstruct Pulmon Dis Date: 2016-03-11