Stopping COPD inhalers can lead to higher risk of flare-ups for 3 months
Stopping long-acting inhalers for chronic obstructive pulmonary disease (COPD) can lead to a sharp rise in flare-ups for around 3 months, a new study supported by the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC) has revealed.
This research by 糖心Vlog官方 and Manchester University NHS Foundation Trust (MFT) scientists is the first of its kind to show people who stop using a prescribed treatment for COPD are at significantly higher risk of exacerbations than expected for their disease.
COPD is the name for a group of lung conditions that cause breathing difficulties, including emphysema and chronic bronchitis. COPD is a common condition, affecting about 1 in 20 people aged over 40 in England, and is a major cause of death and disability.
People with COPD often experience 鈥榚xacerbations鈥� 鈥� sudden flare-ups of breathlessness and coughing that make their condition much worse. These exacerbations are a leading cause of emergency hospital admissions.
Treatment for COPD can help slow the progression of the condition, control symptoms and prevent flare-ups. This includes taking inhalers which deliver medicine into the lungs to help make breathing easier.
Study lead Dr Alexander , researcher in the NIHR Manchester BRC鈥檚 Respiratory Theme and a Senior Clinical Lecturer at 糖心Vlog官方, said: 鈥淢any people with COPD use inhalers every day, but some only use them for a short time and then stop. They may feel better and think they no longer need them, they may struggle to afford them if they are not free of charge, or they may simply forget to use them. Overall, that around half of all prescribed doses are missed.鈥�
In this new study, Manchester researchers analysed data from the 2013-2016 FLAME trial, a large international research project sponsored by Novartis which investigated how patients respond to different COPD treatments. Novartis shared these trial data as per standard data sharing practices with the independent research team in Manchester to answer additional research questions beyond the original study.
The FLAME trial compared 2 types of in more than 3,300 participants with COPD 鈥� these are effective treatments used to open up the airways and reduce inflammation in COPD.
Many people with COPD use inhalers every day, but some only use them for a short time and then stop. They may feel better and think they no longer need them, they may struggle to afford them if they are not free of charge, or they may simply forget to use them. Overall, that around half of all prescribed doses are missed
The team found that when people with COPD stop their inhalers, they face a significantly increased risk of flare-ups for around 3 months. Importantly, during this period the risk is higher not only compared with their own usual level of risk, but also compared with people who were not taking these medicines at all.
The study followed patients for a full year after stopping treatment and showed that this increase in risk is temporary. The excess risk of flare-ups is concentrated in the first 3 months after stopping inhalers, over and above what would normally be expected following treatment discontinuation. After this period, the risk settles and does not persist beyond 3 months.
The study, published in , showed for the first time that stopping a common type of inhaler called a LAMA (long-acting muscarinic antagonist) can lead to these withdrawal effects. It also confirmed that stopping inhalers containing another medication called inhaled corticosteroids (ICS) can increase the risk of flare-ups.
Dr Mathioudakis, who is also an Honorary Consultant Respiratory Physician at MFT and completed his PhD in COPD research at Manchester BRC, said: 鈥淭here are situations where clinicians may need to change or stop an inhaler for specific medical reasons, and in these cases it is important to be aware that short-term 鈥渨ithdrawal effects鈥� can occur.
鈥淢ore importantly, many people with COPD stop their inhalers on their own, often repeatedly, without medical advice. Each time this happens, it can trigger a period of particularly high risk of exacerbations. These new findings highlight the need to clearly communicate the risks of stopping treatment to patients, to help prevent avoidable flare-ups and hospital admissions.鈥�
- The paper 鈥淒isproportionate increase in COPD exacerbation risk for 3 months after discontinuing LAMA or ICS: insights from the FLAME trial鈥� is available : DOI: