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Inhaled Corticosteroids in the Treatment of COPD: The Risk of Developing Pneumonia

Habraken, C.M. (2015) Inhaled Corticosteroids in the Treatment of COPD: The Risk of Developing Pneumonia. Master's Thesis / Essay, Biology.

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Abstract

Inhaled corticosteroids (ICS) are widely used in the treatment of chronic obstructive pulmonary disease (COPD) due to their ability to improve quality of life and to reduce the frequency of exacerbations in a subset of patients. In other subsets of stable COPD patients, however, the use of ICS monotherapy does not appear to impede the progressive decline in lung function and has small and inconsistent effects on symptoms, quality of life, and the severity of exacerbations. Long-term use of ICS may cause systemic adverse effects, including diabetes, cataracts, and osteoporosis. Moreover, several clinical trials have suggested a link between the use of ICS, especially fluticasone propionate (FP), and an elevated risk of developing pneumonia. It remains uncertain whether this risk is similar for all ICS and whether it is dose-related, although the risk appears to be particularly increased using high doses and shorter durations. This thesis aims to provide an answer to the questions of whether ICS monotherapy and/or ICS/LABA combination treatment provide a beneficial addition to standard care in COPD, whether differences with regard to the effectiveness of monotherapy versus combination treatment exist and if differences between specific drugs and/or drug combinations exist, and whether this is the case for all patients or if subsets of patients should be distinguished. In order to answer these questions, currently available literature was reviewed. As the use of ICS is associated with severe systemic side effects, high doses of ICS should only be prescribed to patients with severe COPD. Since ICS and LABA have additive effects over each other, combining treatment may lower the dose of the ICS needed in order to achieve a beneficial effect and thus reduce these adverse effects. Long-term treatment of COPD patients with budesonide/formoterol (FBC; formoterol/budesonide combination treatment) resulted in fewer exacerbations than long-term treatment with salmeterol/fluticasone (SFC; salmeterol/fluticasone combination treatment). Additionally, FP is thought to increase the occurrence of exacerbations and the risk of developing pneumonia. Therefore, the prescription of FBC appears favourable over the prescription of SFC for the treatment of COPD. As no studies comparing different doses of ICS/LABA combination treatment have yet been performed, this is an interesting topic for future research. In addition, treatment of COPD patients may be optimized by distinguishing several phenotypes of the disease and by adjusting treatment to the specific needs of the different subsets of COPD patients.

Item Type: Thesis (Master's Thesis / Essay)
Degree programme: Biology
Thesis type: Master's Thesis / Essay
Language: English
Date Deposited: 15 Feb 2018 08:04
Last Modified: 15 Feb 2018 08:04
URI: http://fse.studenttheses.ub.rug.nl/id/eprint/12754

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