ICS use in COPD according to 2017 GOLD guidelines

In the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report there was a significant change in the guidelines on inhaled corticosteroid (ICS) use. Are there still indications for ICS in chronic obstructive pulmonary disease (COPD) patients who do not need triple therapy (long-acting muscarinic antagonists/long-acting beta-agonists/ICS)?

Jadwiga Wedzicha: Yes, the GOLD 2017 update was a significant change in the way we manage COPD. The guidelines say that we should start with dual bronchodilators for patients who require exacerbation prevention. However, we are still awaiting the trials of triple therapy, which we will report towards the end of the year.

I think it is fair to say that there are some patients whom we would want to treat with ICSs at an earlier stage and these are patients with asthma-COPD overlap syndrome – asthmatics require ICSs. There is also emerging data that if the blood eosinophil count is elevated – for instance, above 300, above 4% – patients should be treated with ICSs and have a good response to treatment with ICSs.

I think we have a group of patients whom we would treat with ICSs at an early stage. I also think that later in the year we will have more data from clinical trials to inform further on triple therapy.