Better Targeting of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease

An investigation that explores how inhaled corticosteroids should be used to treat people with Chronic Obstructive Pulmonary Disease

Kimberley Sonnex, University of Nottingham

Inhaled Corticosteroids (ICS) are shown to help treat some people with chronic obstructive pulmonary disease (COPD) as they decrease the number of worsenings of the disease. However, people with COPD are not all the same; there are differences in the underlying causes of lung inflammation, presence of other illnesses and patient lifestyle factors, such as smoking. Due to these variations, there is uncertainty as to which people with COPD will benefit most from steroid inhalers. There may be some people who are receiving steroid inhalers that are gaining no benefit to their lung disease, but will be experiencing some of the significant and extensive list of side effects; such as mouth and lung infections, diabetes and brittle bones.

This research will use the Clinical Practice Research Datalink (CPRD), a collection of anonymised GP-held patient records in the UK. Data from CPRD will be used to determine which of the differences in people with COPD, as stated above, affect who is more likely to benefit from these inhalers. This will be measured in terms of lung function and the number of short-term worsenings of the condition. Ultimately, this will enable clinicians to identify people with COPD who are most likely to benefit from steroid inhalers, and prescribe accordingly. This will also have the advantage of preventing people who will not benefit from this type of medicine from receiving it, and the extensive adverse effects. This will potentially save money in the health service.

The specific objectives are to investigate the following:

  1. The effect of long-term ICS use in COPD on reduction in lung function decline, and exacerbation rates over time in comparison to people not treated with ICS
  2. The effect of smoking in determining benefit of ICS use in COPD on reducing decline in lung function, and reducing exacerbation rates
  3. The effect of eosinophil counts in determining benefit of ICS use in COPD on reducing decline in lung function and reducing exacerbation rates
  4. Effect of co-diagnosis of asthma in determining benefit of ICS use in COPD on reducing decline in lung function, and reducing exacerbation rates

Summary of potential benefits to patients

This study of outcomes related to inhaled corticosteroid use in COPD will better inform pharmacy practice in all sectors, as it will hopefully, highlight patient groups who would receive more benefit from inhaled corticosteroids.  Better understanding of the implications of prescribing these medicines will assist with developing improved strategies for the management of COPD, with which pharmacists are directly involved. Additionally, this work has the potential to affect health policy, thereby demonstrating the important role that can be played by pharmacists in driving political change.

This project ran from September 2017 to December 2021. The final report is available here.