1.Personalised management of Chronic Obstructive Pulmonary Disease (COPD): Malaysian consensus algorithm for appropriate use of inhaled corticosteroid (ICS) in COPD patients
Nurhayati Mohd Marzuki ; Mat Zuki Mat Jaeb ; Andrea Ban ; Ahmad Izuanuddin Ismail ; Irfhan Ali Hyder Ali ; Mohd Razali Norhaya ; Azlina Samsudin ; Mona Zaria Nasaruddin ; Rozanah Abd Rahman ; Mohd Arif Mohd Zim ; Razul Md. Nazri B Md Kassim ; Yoke Fong Lam ; Aishah Ibrahim ; Noor Aliza Mohd Tarekh ; Sandip Vasantrao Kapse
The Medical Journal of Malaysia 2020;75(6):717-721
Background: Regarding the long-term safety issues with the
use of inhaled corticosteroids (ICS) and the clinical
predominance of dual bronchodilators in enhancing
treatment outcomes in chronic obstructive pulmonary
disease (COPD), ICS is no longer a “preferred therapy”
according to the Global Initiative for Chronic Obstructive
Lung Disease except on top of a dual bronchodilator. This
has necessitated a change in the current therapy for many
COPD patients.
Objective: To determine a standardised algorithm to
reassess and personalise the treatment COPD patients
based on the available evidence.
Methods: A consensus statement was agreed upon by a
panel of pulmonologists in from 11 institutes in Malaysia
whose members formed this consensus group.
Results: According to the consensus, which was
unanimously adopted, all COPD patients who are currently
receiving an ICS-based treatment should be reassessed
based on the presence of co-existence of asthma or high
eosinophil counts and frequency of moderate or severe
exacerbations in the previous 12 months. When that the
patients meet any of the aforementioned criteria, then the
patient can continue taking ICS-based therapy. However, if
the patients do not meet the criteria, then the treatment of
patients need to be personalised based on whether the
patient is currently receiving long-acting beta-agonists
(LABA)/ICS or triple therapy.
Conclusion: A flowchart of the consensus providing a
guidance to Malaysian clinicians was elucidated based on
evidences and international guidelines that identifies the
right patients who should receive inhaled corticosteroids
and enable to switch non ICS based therapies in patients
less likely to benefit from such treatments.
Result Analysis
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