ABCs of COPD - Inhaled Steroids in COPD

Relevance of Blood Eosinophils in ICS treatment

Only a small subset of patients with COPD benefit from inhaled corticosteroid (ICS) therapy. In this video, Prof. Marc Miravitlles (Barcelona Spain) described this subset of COPD patients and the role of blood eosinophil count as a biomarker for patients who should receive ICS therapy.

About the Speaker

Marc Miravitlles is a Senior Researcher and Consultant Specialist from the Pneumology Department of the Hospital Universitary Vall d’Hebron / Vall d’ Hebron Research Institute (VHRI) which is located in Barcelona, Spain. He is the Director of the National Integrated Research Project for COPD (PII) of Spanish Society of Pneumology and Thoracic Surgery (SEPAR), as well as the Guidelines Director of the European Respiratory Society (ERS) from September 2015 to September 2018.

He has had numerous publications on his expertise in Chronic Obstructive Pulmonary Disease and Alpha-1 antitrypsin deficiency and is regarded as an esteemed speaker with numerous speaking engagements in his field of expertise since 1991.

Estimated time of completion: 20 minutes

When to withdraw ICS treatment

Inhaled corticosteroids (ICS) are not without risk and some patients on ICS may need ICS withdrawal. In this video, Prof. Marc Miravitlles (Barcelona Spain) outlined the risks of ICS and the clinical evidence supporting ICS withdrawal in carefully selected COPD patients. He also explained the impact of suboptimal inspiratory flow in the treatment outcomes of patients with COPD.

About the Speaker

Marc Miravitlles is a Senior Researcher and Consultant Specialist from the Pneumology Department of the Hospital Universitary Vall d’Hebron / Vall d’ Hebron Research Institute (VHRI) which is located in Barcelona, Spain. He is the Director of the National Integrated Research Project for COPD (PII) of Spanish Society of Pneumology and Thoracic Surgery (SEPAR), as well as the Guidelines Director of the European Respiratory Society (ERS) from September 2015 to September 2018.

He has had numerous publications on his expertise in Chronic Obstructive Pulmonary Disease and Alpha-1 antitrypsin deficiency and is regarded as an esteemed speaker with numerous speaking engagements in his field of expertise since 1991.

Estimated time of completion: 15 minutes

Cost Effectiveness Study - Tio/Olo vs LABA/ICS

Despite guidelines recommending bronchodilator therapy for most COPD patients, the majority of patients are treated with a LABA/ICS combination instead. In this video, Professor Jennifer Quint (London, UK) reports the results of a non-interventional database study, which sheds light on the real-world benefits of tiotropium-olodaterol compared with LABA/ICS in the treatment of COPD.

About the Speaker

Jennifer Quint is Reader in Respiratory Epidemiology at the Heart and Lung Institute. She is also an Honorary Consultant Physician in Respiratory Medicine at Royal Brompton Hospital, London.

Estimated time of completion: 30 minutes

Evidence Surrounding Triple Therapy in COPD

Despite its harms and the emergence of LABA/LAMA combinations, ICS continues to be prescribed in many COPD patients. In this video, Prof. Marc Miravitlles (Barcelona Spain) explains the appropriate use of ICS as well as ICS-containing triple therapy in the treatment of COPD based on both RCT data and real-world evidence. 

About the Speaker

Marc Miravitlles is a Senior Researcher and Consultant Specialist from the Pneumology Department of the Hospital Universitary Vall d’Hebron / Vall d’ Hebron Research Institute (VHRI) which is located in Barcelona, Spain. He is the Director of the National Integrated Research Project for COPD (PII) of Spanish Society of Pneumology and Thoracic Surgery (SEPAR), as well as the Guidelines Director of the European Respiratory Society (ERS) from September 2015 to September 2018.

He has had numerous publications on his expertise in Chronic Obstructive Pulmonary Disease and Alpha-1 antitrypsin deficiency and is regarded as an esteemed speaker with numerous speaking engagements in his field of expertise since 1991.

Estimated time of completion: 50 minutes

Role and risks of ICS in COPD

The latest GOLD recommendations underscore the role of bronchodilator therapy rather than ICS therapy in most patients, with the latter to be used only in patients presenting with frequent exacerbations. In this video, Prof. Wisia Wedzicha (London, UK) shared data demonstrating the high inappropriate use of ICS therapy in COPD patients and the risks this approach poses on these patients. Disclaimer: GOLD has been updated in 2022 with only minor additions; therefore, the principle mentioned in the lecture remain applicable.

About the Speaker

Wisia Wedzicha is a professor of Respiratory Medicine and Head Respiratory Division from the National Heart and Lung Institute at the Imperial College London. Not only is she an Honorary Consultant Physician at Royal Brompton Hospital in London, UK, but she has also served as a senior investigator from 2011 to 2019 for the NIHR (National Institute for Health Research, UK).

Estimated time of completion: 15 minutes

Appropriate ICS use and triple therapy

LABA/LAMA dual bronchodilator therapy has emerged as the principal strategy for majority of patients with COPD. In this video, Prof. Meilan Han (Michigan, USA) and Prof. John Hurst (London, UK) outlined the benefits of this ICS-free treatment strategy in terms of symptom improvement and reductions in ICS-related adverse effects, as well as the appropriate use of ICS-containing triple therapy with contributions from Dr. Sarah Jarvis.

About the Speaker

MeiLan Han, MD MS, is a Professor of Medicine in the Division of Pulmonary and Critical Care at the University of Michigan. Dr. Han received her medical degree from the University of Washington in Seattle, WA. She completed her residency in Internal Medicine and fellowship in Pulmonary and Critical Care Medicine at the University of Michigan. Dr. Han has also completed a Master's Degree program in Biostatistics and Clinical Study Design at the University of Michigan School of Public Health. Dr. Han is co-chair of the University of Michigan COPD Quality Improvement Committee and co-authored the University of Michigan COPD Guidelines. Dr. Han’s research has focused on defining phenotypes in COPD using imaging. She is a lead investigator for several NIH sponsored COPD studies. She also serves on the scientific advisory committees for both the COPD Foundation and American Lung Association and serves as a spokesperson for the American Lung Association. She is currently an Associate Editor for the American Journal of Respiratory and Critical Care Medicine and serves on the editorial boards for Thorax, Lancet Respiratory Medicine and Journal of the COPD Foundation. She is also a member of the Global Obstructive Lung Disease scientific committee which is charged with developing internationally an internationally recognized consensus statement on COPD diagnosis and management.

John Hurst is Professor of Respiratory Medicine at UCL. He graduated from the University of Edinburgh Medical School in 1997 and was appointed Senior Lecturer then Reader in Respiratory Medicine at UCL, and Honorary Consultant at Royal Free London NHS Foundation Trust in October 2007. He is COPD Lead for the Royal College of Physicians National Asthma and COPD Audit Programme, Chief Editor of the European Respiratory Monograph, and is on the Editorial Board of the American Journal of Respiratory and Critical Care Medicine and the European Respiratory Journal. He chairs the Multi-Morbidity Working Group of the Global Alliance for Chronic Diseases (GACD).

Sarah Jarvis is a General Practitioner (GP), GP trainer and Fellow of the Royal College of General Practitioners (RCGP). She trained at Cambridge and Oxford universities and became a partner in an inner-city general practice in 1990. She is an active medical writer and broadcaster and is the resident doctor for BBC Radio 2 as well as appearing regularly on Channel 5, Good Morning Britain, LBC and other national and regional news channels. In addition, she is the doctor for Good Housekeeping and My Weekly magazines. She is also the Clinical Director of Patient Platform Limited, which includes the Patient Access app (used by 8 million UK patients to access their GP and get health information) and Patient.info, a medical information site with over 100 million visits a year. Finally, she has had a lifelong interest in women’s health – her books include A Younger Woman’s Diagnose-it-yourself Guide, Women’s Health for Life and Pregnancy for Dummies. She founded the Women’s Taskforce at the RCGP and was the RCGP Women’s Health spokesperson for over 15 years.

Estimated time of completion: 20 minutes

When to start ICS and role of blood eosinophils

There has been mounting evidence on the role of blood eosinophils as a biomarker for treatment response in COPD. In this video, Prof. Wisia Wedzicha (London, UK) shared the findings of studies that explored the use of varying cut-offs of blood eosinophils as a biomarker for COPD exacerbations and the evidence supporting the use of ICS-containing therapies in patients with frequent COPD exacerbations.

About the Speaker

Wisia Wedzicha is a professor of Respiratory Medicine and Head Respiratory Division from the National Heart and Lung Institute at the Imperial College London. Not only is she an Honorary Consultant Physician at Royal Brompton Hospital in London, UK, but she has also served as a senior investigator from 2011 to 2019 for the NIHR (National Institute for Health Research, UK).

Estimated time of completion: 20 minutes

When to upscale to triple therapy

Analyses of the IMPACT and ETHOS trials have reported confusing findings on the role of triple therapy in COPD. In this video, Prof. Marc Miravitlles (Barcelona Spain) proposed a possible explanation for these results and provided guidance for upscaling COPD treatment to triple therapy.

About the Speaker

Marc Miravitlles is a Senior Researcher and Consultant Specialist from the Pneumology Department of the Hospital Universitary Vall d’Hebron / Vall d’ Hebron Research Institute (VHRI) which is located in Barcelona, Spain. He is the Director of the National Integrated Research Project for COPD (PII) of Spanish Society of Pneumology and Thoracic Surgery (SEPAR), as well as the Guidelines Director of the European Respiratory Society (ERS) from September 2015 to September 2018.

He has had numerous publications on his expertise in Chronic Obstructive Pulmonary Disease and Alpha-1 antitrypsin deficiency and is regarded as an esteemed speaker with numerous speaking engagements in his field of expertise since 1991.

Estimated time of completion: 15 minutes

Rationale for ICS withdrawal in COPD

Many COPD patients are prescribed ICS-containing regimens despite guidelines advocating otherwise. In this video, Prof. Marc Miravitlles (Barcelona Spain) shared the clinical evidence supporting the role of ICS in a limited number of patients and the rationale for ICS withdrawal in carefully selected COPD patients to reduce the risks of ICS without compromising treatment efficacy.

About the Speaker

Marc Miravitlles is a Senior Researcher and Consultant Specialist from the Pneumology Department of the Hospital Universitary Vall d’Hebron / Vall d’ Hebron Research Institute (VHRI) which is located in Barcelona, Spain. He is the Director of the National Integrated Research Project for COPD (PII) of Spanish Society of Pneumology and Thoracic Surgery (SEPAR), as well as the Guidelines Director of the European Respiratory Society (ERS) from September 2015 to September 2018.

He has had numerous publications on his expertise in Chronic Obstructive Pulmonary Disease and Alpha-1 antitrypsin deficiency and is regarded as an esteemed speaker with numerous speaking engagements in his field of expertise since 1991.

Estimated time of completion: 10 minutes