I have written recently about the number of new ways in which we need to consider medications in our patients with COPD. One of the biggest concerns, which is not new, is the safety and effectiveness of using inhaled corticosteroids (ICS) in our older patients with COPD. Many of the new combination inhalers, i.e. the ones that contain more than one medication, have as a component a corticosteroid. Combination inhalers, which contain a long acting bronchodilator and an ICS are effective, but there has always been a concern about the potential increase in pneumonia in patients using an ICS either alone or in combination.
The risk/benefit ratio associated with ICS use may hinge on identifying which subtype of COPD you are dealing with. Some patients diagnosed with COPD are really asthma patients, some patients have both an asthma component and COPD, and some are purely COPD. How do we identify each group and what is their individual response to inhaled steroids? The answer to this question may be in looking at the eosinophil count in COPD patients. One of the current ideas is that patients with low eosinophil counts will not respond to an ICS, one with medium levels will have a medium response, and one with high levels will have a good response to ICS therapy. Of course, this means we will need to blood test our patients and be aware of the particular levels of response. This may help to reduce the number of patients exposed to a pneumonia risk.