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Perceptions of COPD patients of the proposed withdrawal of inhaled corticosteroids prescribed outside guidelines: a qualitative study

Perceptions of COPD patients of the proposed withdrawal of inhaled corticosteroids prescribed outside guidelines: a qualitative study
Perceptions of COPD patients of the proposed withdrawal of inhaled corticosteroids prescribed outside guidelines: a qualitative study

Global Initiative for Chronic Obstructive Lung Disease guidelines support the prescription of fixed combination inhaled corticosteroids (ICS) and long-acting β-agonists in symptomatic COPD patients with frequent or severe exacerbations, with the aim of preventing them. ICS are frequently also prescribed to COPD patients with mild or moderate airflow limitation, outside guidelines, with the risk of unwanted effects. No investigation to date has addressed the views of these milder COPD patients on ICS withdrawal. The objective is to assess the views of COPD patients with mild or moderate airflow limitation on the staged withdrawal of ICS prescribed outside guidelines. One-to-one semi-structured qualitative interviews exploring COPD patients’ views about ICS use and their attitudes to proposed de-prescription were conducted. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was completed. Seventeen eligible COPD patients were interviewed. Many participants were not aware they were using an ICS. None was aware that prevention of exacerbations was the indication for ICS therapy or the risk of associated side effects. Some were unconcerned by what they perceived as low individual risk. Others expressed fears of worsening symptoms on withdrawal. Most with mild or moderate airflow limitation would have been willing to attempt withdrawal or titration to a lower dosage of ICS if advised by their clinician, particularly if a reasoned explanation were offered. Attitudes in this study to discontinuing ICS use varied. Knowledge of the drug itself, the indications for its prescription in COPD and potential for side effects, was scant. The proposed withdrawal of ICS is likely to be challenging and requires detailed conversations between patients and respiratory healthcare professionals.

COPD exacerbations, Deprescribing, drug withdrawal, primary care
1479-9723
1-9
Gilworth, Gill
bec99bf8-bfb9-4420-acec-a70997eeb5dc
Harries, Timothy
a17ce17e-94b4-414e-84f4-0771efb9b7e2
Corrigan, Chris
ab32bbbf-eb66-46b6-a8c7-1603b4b8a546
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
White, Patrick
aa8d0bb0-0a13-4c57-8b3b-e8fa19b46b93
Gilworth, Gill
bec99bf8-bfb9-4420-acec-a70997eeb5dc
Harries, Timothy
a17ce17e-94b4-414e-84f4-0771efb9b7e2
Corrigan, Chris
ab32bbbf-eb66-46b6-a8c7-1603b4b8a546
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
White, Patrick
aa8d0bb0-0a13-4c57-8b3b-e8fa19b46b93

Gilworth, Gill, Harries, Timothy, Corrigan, Chris, Thomas, Mike and White, Patrick (2019) Perceptions of COPD patients of the proposed withdrawal of inhaled corticosteroids prescribed outside guidelines: a qualitative study. Chronic Respiratory Disease, 16, 1-9. (doi:10.1177/1479973119855880).

Record type: Article

Abstract

Global Initiative for Chronic Obstructive Lung Disease guidelines support the prescription of fixed combination inhaled corticosteroids (ICS) and long-acting β-agonists in symptomatic COPD patients with frequent or severe exacerbations, with the aim of preventing them. ICS are frequently also prescribed to COPD patients with mild or moderate airflow limitation, outside guidelines, with the risk of unwanted effects. No investigation to date has addressed the views of these milder COPD patients on ICS withdrawal. The objective is to assess the views of COPD patients with mild or moderate airflow limitation on the staged withdrawal of ICS prescribed outside guidelines. One-to-one semi-structured qualitative interviews exploring COPD patients’ views about ICS use and their attitudes to proposed de-prescription were conducted. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was completed. Seventeen eligible COPD patients were interviewed. Many participants were not aware they were using an ICS. None was aware that prevention of exacerbations was the indication for ICS therapy or the risk of associated side effects. Some were unconcerned by what they perceived as low individual risk. Others expressed fears of worsening symptoms on withdrawal. Most with mild or moderate airflow limitation would have been willing to attempt withdrawal or titration to a lower dosage of ICS if advised by their clinician, particularly if a reasoned explanation were offered. Attitudes in this study to discontinuing ICS use varied. Knowledge of the drug itself, the indications for its prescription in COPD and potential for side effects, was scant. The proposed withdrawal of ICS is likely to be challenging and requires detailed conversations between patients and respiratory healthcare professionals.

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1479973119855880 - Version of Record
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More information

Accepted/In Press date: 4 June 2019
e-pub ahead of print date: 13 June 2019
Keywords: COPD exacerbations, Deprescribing, drug withdrawal, primary care

Identifiers

Local EPrints ID: 432055
URI: http://eprints.soton.ac.uk/id/eprint/432055
ISSN: 1479-9723
PURE UUID: 82d4dccc-0871-4a89-a6fd-cff45145029b

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Date deposited: 28 Jun 2019 16:30
Last modified: 07 Oct 2020 00:24

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Contributors

Author: Gill Gilworth
Author: Timothy Harries
Author: Chris Corrigan
Author: Mike Thomas
Author: Patrick White

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