Indications for Inhaled Corticosteroids in COPD

Primary Indications for ICS in COPD

The American Thoracic Society recommends ICS, always in combination with long-acting bronchodilators, for patients with ≥2 moderate exacerbations or ≥1 severe exacerbation in the previous year despite appropriate maintenance bronchodilator therapy 1, 3
Patients with severe lung function impairment, such as FEV1 <50% predicted, who experience frequent exacerbations may benefit from ICS therapy, as recommended by the European Respiratory Society 4, 5
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) suggests that patients with features of asthma-COPD overlap syndrome (ACOS) should receive ICS as part of their treatment regimen 3, 4

The American College of Chest Physicians recommends that ICS should always be used in combination with bronchodilators, not as monotherapy, for patients with high risk of exacerbations 2
Triple therapy (ICS/LAMA/LABA) is recommended for symptomatic patients with high risk of exacerbations, as suggested by the American Thoracic Society 1
Patients in GOLD group D (high symptom burden and high exacerbation risk) may benefit from triple therapy, according to the American Journal of Respiratory and Critical Care Medicine 3

GOLD C patients (low symptoms, high exacerbation risk) may benefit from ICS+LAMA or ICS+LABA+LAMA, as recommended by the European Respiratory Society 4
GOLD D patients (high symptoms, high exacerbation risk) may benefit from LAMA+LABA+ICS, according to the American Journal of Respiratory and Critical Care Medicine 3, 4

The American Thoracic Society warns that ICS use in COPD is associated with increased risk of pneumonia, particularly in older patients and those with lower BMI 2, 3
Patients with blood eosinophils <100 cells/μL may have minimal benefit from ICS therapy and increased pneumonia risk, as suggested by the American Journal of Respiratory and Critical Care Medicine 2