Changes in the microbiome observed after removal of ICS in patients with COPD

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A new survey of inhaled corticosteroids (ICS) has found that patients with moderate to very severe chronic obstructive pulmonary disease (COPD) who stopped treatment experienced favorable changes in microbiome composition and improvements in exacerbations.

The new data was presented today at the American Thoracic Society’s 2022 International Conference in San Francisco.

Although ICS have been shown to reduce the frequency of exacerbations in patients with COPD and eosinophilic inflammation, they have also been associated with an increased risk of pneumonia.

Additionally, previous research has cited increased bacterial load in patients with eosinophilic disease who have been treated with ICS.

With the current study, an investigative team led by Holly Keir, PhD, of the University of Dundee, hypothesized that removing ICS would reduce bacterial load and alter the airway microbiome in a study of 80 patients with COPD.

Patients were randomized to receive either tiotropium and olodaterol (discontinuation of ICS) or fluticasone furoate/vilanterol (continuation of ICS) for 6 months.

“Interestingly, we did not see the reduction in bacterial load that we expected when we removed the ICS; however, we saw changes in the microbiome itself,” Keir said. “So we saw massive changes in beta diversity following ICS withdrawals. When we looked in more detail at what was driving these changes, we found that in patients who had undergone withdrawal of the CSIs, there was an increase in commensal taxa, which we generally consider beneficial.

In patients who continued ICS, Keir and his colleagues observed higher levels of things like haemophilia and streptococcus, which are known to be pathogenic in people with COPD.

Lugogo added that the study results were consistent with the recommendations of international ERS guidelines, which suggest that patients with eosinophil counts below 300 cells per microliter, fewer than two exacerbations, and 2 exacerbations per year , should consider removing CSIs.

“That’s what we want people to think about: thinking about the ERS guidelines, looking at blood eosinophil counts and thinking that if they’re on ICS, do we really have to withdraw? Can exacerbations be reduced? And when can we have patients with a more favorable microbiome? »

Watch the full interview with Dr. Keir above and click here for more on ATS 2022.


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