Inhaled Corticosteroid Withdrawal in Chronic Obstructive Pulmonary Disease (COPD)
Inhaled Corticosteroid Withdrawal in Chronic Obstructive Pulmonary Disease (COPD)
According to the WISDOM study, withdraw of inhaled steroids has no effect on the acute
 exacerbation of chronic obstructive pulmonary disease (COPD), but the lung function of
 patients with COPD is significantly reclined. In the subgroup analysis of this study,
 patients with COPD were found to have continued to use inhaled steroids in patients with
 eosinophilic leukocytes greater than 400 cells/ul or whom has more than two episodes of
 exacerbation per year. However, in SUNSET study, it was pointed out that withdraw of inhaled
 steroids had no effect on lung function in patients with COPD, but it was also found that in
 patients with COPD, eosinophilic leukocytes in the blood were greater than 300 cells/ul, have
 a better therapeutic response in steroid inhalation. In addition, some studies have shown
 that in patients with COPD, a decline in lung function after discontinuation of inhaled
 steroids can make the patient's clinical symptoms worse and increase the risk of acute
 exacerbations. However, in other comprehensive analytical studies, there are different
 outcomes. There is no statistically significant difference in the risk of acute exacerbation
 in patients with COPD after discontinuation of inhaled steroids.

 In past studies, it was noted that inhaled steroids cause an increased risk of pneumonia in
 patients with COPD. However, in these studies, the diagnosis of pneumonia was only from the
 clinician's suspicion without clear symptom assessment, laboratory examination,
 microbiological evidence or imaging assessment. Therefore, further research is needed to
 assess whether patients are suitable for the reduction of inhaled steroids and the impact of
 COPD in clinical treatment.
Inclusion Criteria:

 -  Confirmed patients with COPD (at least one lung function test post bronchodilator
 FEV1/FVC <70% before the start of the study)

 -  Age ≥ 40 years old

 -  No acute attack record within half a year

 -  Triple therapy (dual long-acting inhaled bronchodilator and inhaled steroid) is stable
 for more than six months.

 -  Eosinophil count in blood <300 cells/ul

 -  Clinical symptom assessment CAT score <20

 Exclusion Criteria:

 -  Suspected or diagnosed with asthma

 -  Age <40 years

 -  Within half a year, there is a record of moderate to severe acute attacks

 -  Eosinophil count in blood ≥300 cells/ul

 -  Clinical symptom assessment CAT score ≥20