Patients with COPD are treated with drugs to improve the breathing ability in combination with inhaled corticosteroids to reduce the risk of acute worsening of the lung conditions. But the balance between reduced exacerbations and increased adverse effects of the drugs depends on the dose and on patient characteristics. Researchers from the University of Zurich now show how to personalize treatments to optimally balance benefits and side effects.
Patients with chronic obstructive pulmonary disease (COPD) suffer from a permanent narrowing of the airways making breathing difficult. The narrowing is caused by inflammation of the small airways, resulting in mucus production and destruction of lung tissue. Inhaled corticosteroids are commonly used in combination with long-acting bronchodilators to prevent acute worsening of the lung condition – so-called exacerbations – in patients with COPD. While inhaled corticosteroids reduce inflammation or exacerbations, bronchodilators improve breathing by broadening the bronchi.
Benefit of inhaled corticosteroids depends on three factors
There is a longstanding debate about the use of inhaled corticosteroids in the heterogeneous and wide range of COPD patients. Guidelines propose a personalized treatment approach, but they remain rather vague, since it is unclear for whom the benefits outweigh the harmful side effects. A study lead by Henock Yebyo, postdoctoral researcher at the Epidemiology, Biostatistics and Prevention Institute of the University of Zurich (UZH), now sheds light on this challenge. "Our results show that three key factors influence the balance of treatment benefits and side effects of adding different doses of inhaled corticosteroid: The risk of exacerbation, the amount of certain blood cells and the patient's age," says first author Yebyo.
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