Withdrawing Inhaled Steroids in Patients with Severe Chronic Obstructive Pulmonary Disease

Patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) often end up on various combinations of inhaled long-acting β-agonists (LABAs; e.g., salmeterol), long-acting antimuscarinic antagonists (LAMAs; e.g., tiotropium), and glucocorticoids (e.g., fluticasone). In this study (sponsored by the maker of tiotropium), researchers sought to determine whether patients taking all three medications could be weaned safely from glucocorticoids.

Nearly 2500 patients with severe COPD (mean forced expiratory volume in 1 second [FEV₁], 34% of predicted) were stabilized on triple therapy (salmeterol, tiotropium [Spiriva], and fluticasone [500 μg twice daily]) for 6 weeks. Then, in a double-blind, placebo-controlled, randomized phase, t…