This section provides answers from Professor Wisia Wedzicha and Dr Kai Beeh to the FAQs from the COPD Spotlight Webinar entitled “Can we avoid ICS in COPD? Time for clarity”. Click on the questions below to view the answer.

FAQ - COPD Spotlight Webinar Can we avoid ICS in COPD? Time for clarity

Question 1

A patient receiving triple therapy moves from Global initiative for chronic Obstructive Lung Disease (GOLD) group D to B. Should we re-evaluate this patient every 12 months or leave him/her on triple therapy because inhaled corticosteroid (ICS) dependency was previously shown?

Question 2

If a patient is in Global initiative for chronic Obstructive Lung Disease (GOLD) group D and is stable on long acting β2 agonist/long-acting muscarinic antagonist (LABA/LAMA), but their eosinophil level is above 300 cells/µL, should we escalate to triple therapy or not?

Question 3

Is one long acting β2 agonist/long-acting muscarinic antagonist (LABA/LAMA) combination superior to others and why?

Question 4

Does a high eosinophil count indicate asthma-COPD overlap (ACO)?

Question 5

Would you measure blood eosinophils in non-frequently exacerbating patients? If yes, would you make a distinction between patients with 0 and 1 exacerbation in your approach?

Additional commonly-asked questions, answered by our faculty consisting of Dr Beeh and Professor Burgel. Can be found here. Topics discussed include the evolving evidence from the FLAME study, the GOLD 2017 recommendations for COPD management, and how data impact the treatment of patients in clinical practice.

Click on the questions below to view the answer. All the references for this section can be found here.


Could the results from FLAME be considered a long-acting β2-agonist/long-acting muscarinic antagonist (LABA/LAMA) class effect?

Dr Beeh discusses the FLAME study and what conclusions about LABA/LAMA can be drawn from the results.

Most exacerbation studies in COPD focus on moderate or severe exacerbations. Why did FLAME include all (mild/moderate/severe) exacerbations as the primary endpoint instead?

Dr Beeh discusses why the FLAME study includes all exacerbation severities, stating that this reflects the importance of preventing every exacerbation.

Why is the time-to-first exacerbation studied in clinical trials?

Dr Beeh explains how the time-to-first exacerbation and the rate of exacerbations should be used together to produce an accurate picture of pharmacological efficacy.

In which patients do you think inhaled corticosteroids (ICS) treatment should be withdrawn?

Dr Beeh considers the situations in which ICS treatment should be withdrawn.

Analyses of WISDOM data suggest that ICS withdrawal increased exacerbation risk in a certain subset of patients. What proportion of patients in clinical practice have these characteristics?

Dr Beeh analyses the WISDOM study which suggests that ICS withdrawal had the greatest impact on subsequent exacerbation rate in patients with a blood eosinophil count of >400 cells/μL and a history of ≥2 exacerbations.

How do you identify COPD patients who would benefit from inhaled corticosteroid (ICS) treatment?

Professor Burgel describes the various criteria that can be used to ascertain if a patient would benefit from ICS treatment.