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BibTex format

@article{Hakim:2019:10.1164/rccm.201808-1590LE,
author = {Hakim, A and Khan, Y and Esteban, I and Meah, S and Miller-Larsson, A and Barnes, PJ and Usmani, OS},
doi = {10.1164/rccm.201808-1590LE},
journal = {American Journal of Respiratory and Critical Care Medicine},
pages = {662--664},
title = {Low-dose budesonide/formoterol counteracts airway inflammation and improves lung function in COPD},
url = {http://dx.doi.org/10.1164/rccm.201808-1590LE},
volume = {199},
year = {2019}
}

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TY  - JOUR
AB  - The  latest  Global  Initiative  for  Chronic  Obstructive  Lung  Disease  (GOLD)  document recommends  new  treatment  algorithms,  with  inhaled  corticosteroids  (ICS)  use  only  in moderate-to-severely  symptomatic  COPD  patients  with  repeated  exacerbations,  where the  emphasis  is  to  review  ICS  use  and  to  reduce  ICS  dosing  (1).  Indeed,  safety concerns  of  pneumonia  (2)  with  high-dose  ICS  has  further  concerted  focus  upon  using appropriate doses of ICS. It is well-established that ICS in combination with long-acting β2-adrenoceptor  agonist  (LABA)  can  decrease  exacerbations,  improve  symptomsand increase  quality  of  life  in  patients  with  COPD  (3-4),  but  nonetheless,  the  rationale  to consider step-down of ICS is supported by several clinical studies (5). The Withdrawal of Inhaled  Steroids  during  Optimized  Bronchodilator  Management (WISDOM)  trial  studied severe   COPD   patients   on   therapy   with   ICS,   LAMA   and   LABA,   where   stepwise withdrawal  of  ICS  did  not  lead  to  an  increase  in  exacerbations  compared  to  continued ICS  use  (6).  Determining  the  optimal  dose  of  ICS  and  LABA  combination  therapy  is  of great  biological  and  clinical  importance  in  order  to  address  safety  concerns  associated with high-dose ICS use. There is in vitro evidence to support the clinical practice of using low-dose ICS. Low-dose ICS in combination with LABA enhances corticosteroid function by  enhancing  glucocorticoid  receptor  (GR)  activity  (7)  and  suppresses  the  release  of inflammatory   mediators   (8).   However,   it   is   unknown   whether   this   observation   of enhanced corticosteroid function with low-dose ICS/LABA has a direct effect on airways inflammation and lung function. Our study investigated the cellular function that may be relevant and underpin the clinical approach to lowering the dose of ICS therapy in COPD patients.  We  compared  the  single  administra
AU  - Hakim,A
AU  - Khan,Y
AU  - Esteban,I
AU  - Meah,S
AU  - Miller-Larsson,A
AU  - Barnes,PJ
AU  - Usmani,OS
DO  - 10.1164/rccm.201808-1590LE
EP  - 664
PY  - 2019///
SN  - 1073-449X
SP  - 662
TI  - Low-dose budesonide/formoterol counteracts airway inflammation and improves lung function in COPD
T2  - American Journal of Respiratory and Critical Care Medicine
UR  - http://dx.doi.org/10.1164/rccm.201808-1590LE
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30540486
UR  - http://hdl.handle.net/10044/1/65336
VL  - 199
ER  -

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Professor Sir Peter Barnes, FRS, FMedSci

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