RT Generic
T1 Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level.
A1 Lopez-Campos, Jose Luis
A1 Carrasco Hernandez, Laura
A1 Muñoz, Xavier
A1 Bustamante, Víctor
A1 Barreiro, Esther
K1 chronic obstructive pulmonary disease
K1 inhaled therapy
K1 pharmacological treatment
K1 step-down
K1 step-up
AB The implementation of potential new step-up or step-down treatment recommendations in response to current guidelines is one of the main challenges currently faced in actual daily practice settings. In the present narrative review, we aim to discuss the relevance of these step-up and step-down proposals at the patient level in daily clinical practice. In particular, we aim to review the challenges associated with inhaled maintenance therapy for chronic obstructive pulmonary disease (COPD) in four clinical scenarios. First, we discuss the step up from single to double bronchodilation, including current controversies regarding the addition of a second bronchodilator versus initial treatment with two bronchodilators. Second, we discuss the step up from double bronchodilation to triple therapy while challenging current indications for inhaled steroid therapy and discussing triple therapy designs. Third, we discuss the step down from triple therapy to double bronchodilation while evaluating the effect of this downshift in risk categories on the patient according to the new classifications. Finally, we discuss the step down from double to single bronchodilation, with a special focus on safety. We believe this review will help to highlight the most relevant discussion points regarding the treatment of COPD in a manner that will stimulate and guide related clinical research.
PB John Wiley & Sons, Inc.
YR 2018
FD 2018-08-14
LK http://hdl.handle.net/10668/12620
UL http://hdl.handle.net/10668/12620
LA en
NO Lopez-Campos JL, Carrasco Hernández L, Muñoz X, Bustamante V, Barreiro E. Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level. Respirology. 2018 Jun 20. (23); 818-827
DS RISalud
RD Apr 6, 2025