Optimizing de-escalation of inhaled corticosteroids in COPD: a systematic review of real-world findings

Introduction: To date, there is solid evidence from randomized controlled trials (RCTs) supporting the rationale for withdrawal from inhaled corticosteroids (ICSs) in most patients suffering from chronic obstructive pulmonary disease (COPD). However, the populations selected for RCTs only partially represent the real-life population of COPD patients. Areas covered: In this review, a systematic synthesis of data useful in the daily clinical practice was provided in order to guide clinicians toward the optimal approach for the de-escalation of ICSs in COPD. Expert opinion: De-escalation to ICS is a procedure that allows optimizing the pharmacological therapy of stable COPD patients. While only a minority of severe COPD patients that are symptomatic and/or at high risk of exacerbation may really need of triple therapy, most patients should be de-escalated/switched from ICS-containing regimen toward dual bronchodilator therapy, or even to single bronchodilator regimen in patients affected by less severe form of COPD.