Table 2 Panellist’s opinion on how ICS therapy should be withdrawn from their COPD patients.
Results by specialty | |||
|---|---|---|---|
Total sample (N = 127) | General practitioners (N = 45) | Pulmonologists (N = 82) | |
In your decision to withdraw ICS therapy, which parameter do you rely on most? (Multiple choice option) | |||
Frequency of exacerbations | 35.4% | 42.2% | 31.7% |
Level of blood eosinophil counts | 1.6% | 2.2% | 1.2% |
Always both in combination | 48.8% | 44.4% | 51.2% |
None of these two | 3.9% | 0.0% | 6.1% |
Other factors | 10.2% | 11.1% | 9.8% |
For what reasons do you think ICS-treated patients can be eligible for ICS withdrawal? (Multiple choice option) | |||
Patients with pneumonia | 68.5% | 73.3% | 65.9% |
No longer indication for ICS | 87.4% | 93.3% | 84.1% |
Lack of response to ICS | 88.2% | 86.7% | 89.0% |
Patients without asthma | 39.4% | 46.7% | 35.4% |
Patients with diabetes | 10.2% | 11.1% | 9.8% |
Patients with osteoporosis/osteopenia | 17.3% | 17.8% | 17.1% |
Patients with cardiovascular disease | 1.6% | 4.4% | 0.0% |
Patients with ICS-related side effects | 81.1% | 86.7% | 78.0% |
Patients should never be withdrawn from ICS treatment | 0.0% | 0.0% | 0.0% |
How confident you are in the following situations: | |||
Withdrawal in case of no longer indication for ICS. Confident, % | 87.4% | 91.1% | 85.4% |
ICS withdrawal in case of lack of response to ICS. Confident, % | 77.2% | 82.2% | 74.4% |
ICS withdrawal in case of pneumonia. Confidenta | 63.0% | 77.8% | 54.9% |
In your personal opinion, how should ICS be withdrawn in patients on LABA/ICS therapy? (Multiple choice option) | |||
Gradual ICS dose reduction without adding any other treatment in all patients | 0.8% | 0.0% | 1.2% |
Gradual ICS dose reduction without adding any other treatment in patients on high dose ICS | 3.9% | 0.0% | 6.1% |
Abrupt ICS withdrawal without adding any other treatment | 7.9% | 6.7% | 8.5% |
Gradual dose reduction and LAMA/LABA treatment introduction at the same timea | 55.1% | 68.9% | 47.6% |
Gradual dose reduction and LAMA/LABA treatment once ICS is completely withdrawn | 0.8% | 2.2% | 0.0% |
Abrupt ICS withdrawal and LAMA/LABA treatment once ICS is completely withdrawn | 59.1% | 37.8% | 70.7% |
ICS should not be withdrawn from patients on LABA/ICS | 0.0% | 2.2% | 1.2% |
Other | 1.6% | 0.0% | 3.2% |
In your personal opinion, how should ICS be withdrawn in patients on triple therapy (LAMA/LABA/ICS)? (Multiple choice option) | |||
Gradual ICS dose reduction maintaining LAMA/LABA combinationa | 28.3% | 55.6% | 13.4% |
Abrupt ICS withdrawal maintaining LAMA/LABA combinationa | 74.0% | 46.7% | 89.0% |
ICS should not be withdrawn from patients on LABA/ICS | 0.0% | 0.0% | 0.0% |
Other | 0.8% | 2.2% | 0.0% |
In your personal opinion, what drives the choice of LAMA/LABA combination when withdrawing ICS in patients who were on triple therapy? (Multiple choice option) | |||
Same devicea | 89.8% | 97.8% | 85.4% |
Same LAMA | 6.3% | 8.9% | 4.9% |
Same LABA | 6.3% | 8.9% | 4.9% |
Switch to a potentially more effective LAMA | 9.4% | 6.7% | 11.0% |
Switch to a potentially more effective LABA | 5.5% | 2.2% | 7.3% |
Other | 2.4% | 0.0% | 3.7% |
In your personal opinion, after ICS withdrawal, how should patients with COPD be monitored? (Multiple choice option) | |||
No specific follow-up | 0.0% | 0.0% | 0.0% |
Planned follow-up visit/call 1 month after ICS withdrawala | 73.2% | 86.7% | 65.9% |
Planned visit for spirometry | 33.9% | 24.4% | 39.0% |
Patients should have the possibility to communicate with me or another healthcare professional in case of questions | 56.7% | 73.3% | 47.6% |
Patients should have the possibility to call me or another healthcare professional in case of complaints | 32.3% | 42.2% | 26.8% |
Other | 0.8% | 0.0% | 1.2% |
Please indicate the reasons that could indicate the need for reintroducing ICS (Multiple choice option) | |||
Worsening of COPD symptoms (such as breathlessness) | 68.5% | 75.6% | 64.6% |
Exacerbations after ICS withdrawala | 95.3% | 88.9% | 98.8% |
Persistent adverse events after ICS withdrawala | 5.5% | 11.1% | 2.4% |
Significant worsening of spirometry | 66.1% | 62.2% | 68.3% |
Patient preference | 7.9% | 6.7% | 8.5% |
Others | 0.0% | 0.0% | 0.0% |
What should be done in such cases? (Multiple choice option) | |||
Back to the ICS treatment at the same doses than before | 35.4% | 22.2% | 42.7% |
Back to the ICS treatment at lower doses than before | 63.8% | 75.6% | 57.3% |
Keep the ICS withdrawal | 0.8% | 2.2% | 0.0% |
Other | 0.0% | 0.0% | 0.0% |
