Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jan 22;13(2):213.
doi: 10.3390/biom13020213.

Practical Recommendations for a Selection of Inhaled Corticosteroids in COPD: A Composite ICO Chart

Keiji Oishi  1 , Kazuto Matsunaga  1 , Tasuku Yamamoto  1 , Kazuki Matsuda  1 , Yoriyuki Murata  1 , Tsunahiko Hirano  1
Affiliations
Review

Practical Recommendations for a Selection of Inhaled Corticosteroids in COPD: A Composite ICO Chart

Keiji Oishi et al. Biomolecules. .

Abstract

The use of inhaled corticosteroids (ICS) for the maintenance of bronchodilator treatment in patients with chronic obstructive pulmonary disease (COPD) is controversial. While some patients achieve clinical benefits, such as fewer exacerbations and improved symptoms, others do not, and some experience undesired side effects, such as pneumonia. Thus, we reviewed the evidence related to predictors of ICS therapy treatment response in patients with COPD. The first priority clinical markers when considering the efficacy of ICS are type 2 inflammatory biomarkers, followed by a history of suspected asthma and recurrent exacerbations. It is also necessary to consider any potential infection risk associated with ICS, and several risk factors for pneumonia when using ICS have been clarified in recent years. In this article, based on the evidence supporting the selection of ICS for COPD, we propose an ICS composite that can be added to the COPD (ICO) chart for use in clinical practice. The chart divided the type 2 biomarkers into three ranges and provided recommendations (recommend, consider, and against) by combining the history of suspected asthma, history of exacerbations, and risk of infection.

Keywords: COPD; ICS; asthma; exacerbations; pneumonia; type 2 inflammatory biomarkers.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Response rate to ICS therapy in patients with COPD stratified by type 2 biomarkers. Abbreviations: B-Eos, blood eosinophil counts; FeNO, fractional exhaled nitric oxide.
Figure 2
Figure 2
Prognosis of an ICS user with COPD with type 2 biomarker-high or -low. The clinical outcomes of the ICS user in COPD with T2BM-high can be improved, and T2BM-low exacerbated. Dotted and solid lines depict the time course of clinical outcomes, such as symptoms, pulmonary function decline, and exacerbations, by each strategy. Dotted lines; ICS user with COPD with T2BM-high, Solid lines; ICS user with COPD with T2BM-low. Adapted with permission from Ref. [27]. Copyright 2023 Japanese Society of Internal Medicine. Abbreviations: ICS, inhaled corticosteroid; COPD, chronic obstructive pulmonary disease; T2BM, type 2 biomarker.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Stolz D., Mkorombindo T., Schumann D.M., Agusti A., Ash S.Y., Bafadhel M., Bai C., Chalmers J.D., Criner G.J., Dharmage S.C., et al. Towards the elimination of chronic obstructive pulmonary disease: A Lancet Commission. Lancet. 2022;400:921–972. doi: 10.1016/s0140-6736(22)01273-9. - DOI - PMC - PubMed
    1. Global Initiative for Chronic Obstructive Lung Disease. Nov 14, 2023. [(accessed on 14 November 2022)]. Available online: https://goldcopd.org/
    1. Japanese Respiratory Society . Guidelines for the Diagnosis and Treatment of COPD. 6th ed. Japanese Respiratory Society; Tokyo, Japan: 2022. [(accessed on 14 November 2022)]. Available online: https://www.jrs.or.jp/publication/jrs_guidelines/20220512084311.html.
    1. Miravitlles M., Calle M., Molina J., Almagro P., Gómez J.T., Trigueros J.A., Cosío B.G., Casanova C., López-Campos J.L., Riesco J.A., et al. Spanish COPD Guidelines (GesEPOC) 2021: Updated Pharmacological treatment of stable COPD. Arch. Bronconeumol. 2022;58:69–81. doi: 10.1016/j.arbres.2021.03.005. - DOI - PubMed
    1. Park Y.B., Rhee C.K., Yoon H.K., Oh Y.M., Lim S.Y., Lee J.H., Yoo K.H., Ahn J.H. Revised (2018) COPD Clinical Practice Guideline of the Korean Academy of Tuberculosis and Respiratory Disease: A Summary. Tuberc. Respir. Dis. 2018;81:261–273. doi: 10.4046/trd.2018.0029. - DOI - PMC - PubMed

MeSH terms

Grants and funding

This research received no external funding.