ICS in COPD - friend or foe

Inhaled Coticosteroids in COPD – Friend or Foe?
For the Motion

Dr Irfhan Ali Bin Hyder Ali

Inhaled Corticosteroids have long been used in the treatment for COPD, and is rightfully mentioned and acknowledged in most international guidelines, including the latest GOLD guidelines 2024.

It is recognized that COPD does have an element of inflammation although not as pronounced as asthma, and anti-inflammatory drugs such as inhaled steroids have a major part to play in treating this disease. There are numerous clinical trials that support the role of steroids in COPD thus their prominent mention in guidelines.

There are certain groups of patients for whom ICS may not have any benefit, and it is imperative for the treating clinician to be wary of these groups. These include those with recurrent pneumonias, history of previous tuberculosis infection and patients with low eosinophil counts. On the contrary, patients with recurrent exacerbations, high eosinophil counts and those with possibility of asthma will likely benefit  from the addition of ICS.

Thus, ICS does have an important role in COPD and is definitely considered a friend in our armamentarium of medications against COPD. 

Andrea Ban Yu Lin

Inhaled corticosteroids (ICS) have long been a cornerstone in the management of chronic obstructive pulmonary disease (COPD), yet their safety profile suggest a more cautious and selective use. While ICS can reduce exacerbations in some patients, their overall impact on long-term disease progression and mortality is questionable. Moreover, ICS are associated with significant adverse effects, including increased risk of pneumonia, osteoporosis, and diabetes, which can outweigh their potential benefits. The indiscriminate use of ICS in COPD, particularly in patients without a history of frequent exacerbations or those with eosinophil counts below a certain threshold, may lead to unnecessary exposure to these risks. Furthermore, the effectiveness of ICS in COPD is markedly less pronounced than in asthma, underscoring the need for a more tailored approach based on individual patient profiles. The shift towards a more personalized treatment regimen, emphasizing non-ICS therapies, aligns with the goal of optimizing patient care while minimizing harm. In conclusion, the routine use of ICS in COPD should be re-evaluated, advocating for their reserved application in select patient populations where the benefits clearly outweigh the risks. This approach not only enhances patient safety but also promotes more effective and individualized COPD management strategies.