Medicine Changes and Disease Progression
Managing COPD can be a complicated affair, and typically involves one or more medications to control the daily symptoms and treat exacerbations. Unfortunately, sometimes the ideal drug at one point becomes a major problem down the road, as a recent Dutch study has found.
What the study shows:
Patients who discontinue their long-term inhaled corticosteroid (ICS) could suffer the consequences of withdrawal for up to five years, including worsening lung function, airway hyper-responsiveness (AHR), and quality of life.
The researchers from Leiden University published their findings in the journal CHEST, outlining the various levels of decline based on the groups of patients and their different habits. For those who completely discontinued their use of ICS after the prescribed 30 month treatment, their quality of life dropped quite drastically (measured by the St. George’s Respiratory Questionnaire, the Clinical COPD questionnaire, and the Medical Research Council Dyspnea Score). Lung function and AHR both dropped considerably each year, too.
The findings have led the experts to conclude that the physical benefits of ICS are only seen during the actual therapy — they do not continue after the corticosteroid is stopped. On the other hand, taking inhaled corticosteroids indefinitely could cause trouble as well, so it may not be the best course of action for COPD patients.
The leader of the team, Lisette Kunz, MD, suggests that the best way forward is to carefully evaluate each case of COPD, and make recommendation for long-term medication based on each individual’s unique set of circumstances. Beginning corticosteroids should not be a universal prescription, but it should also not be discounted if your body is likely to benefit more than it will suffer.
COPD tends to have a personalized course, and though your doctor can tailor a particular treatment plan to you, there may be more factors at play than you imagine. The good news is that the University of Copenhagen study suggests that examination and intervention for COPD could take place earlier, before the disease advances and become more difficult to treat.
As for the findings from the Leiden University team, there’s a concern that the sample size may be too small to draw solid conclusions, but it also raises an important point about close consideration of medication at the beginning of treatment for long-term health and happiness.