Discontinuing COPD Inhalers Leads to Significant Spike in Flare-Ups, Study Finds
A new study, supported by the National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre (BRC), reveals that stopping long-acting inhalers for chronic obstructive pulmonary disease (COPD) can cause a significant increase in flare-ups for approximately three months. Researchers from The University of Manchester and Manchester University NHS Foundation Trust (MFT) identified that individuals who cease prescribed COPD treatment face a considerably higher risk of exacerbations than previously anticipated for their condition.
Individuals who cease prescribed COPD treatment face a considerably higher risk of exacerbations than anticipated for their condition.
Understanding COPD and Its Treatments
COPD encompasses lung conditions such as emphysema and chronic bronchitis, which lead to breathing difficulties. It impacts about 1 in 20 people over 40 in England and is a leading cause of death and disability. Patients frequently experience 'exacerbations,' characterized by sudden increases in breathlessness and coughing, often necessitating emergency hospital admissions.
Treatments for COPD, typically involving inhalers that deliver medication directly to the lungs, are designed to slow disease progression, control symptoms, and prevent these flare-ups.
Why Patients Discontinue Treatment
Dr. Alexander Mathioudakis, the study lead, observed that many individuals with COPD discontinue inhaler use for various reasons, including feeling better, financial constraints, or simply forgetting. It is estimated that approximately half of all prescribed doses are missed.
The Study's Methodology and Key Discoveries
This research analyzed data from the 2013-2016 FLAME trial, an international research project funded by Novartis. The trial compared two types of combination inhalers across more than 3,300 COPD participants. The Manchester-based researchers discovered that stopping inhalers led to a significantly increased risk of flare-ups for around three months. During this initial period, the risk was elevated compared to both the patients' usual risk levels and individuals not taking these medications.
The study, published in Thorax, followed patients for a year after treatment cessation. It determined that this increased risk is temporary, predominantly concentrated within the initial three months, after which the risk stabilizes. The findings confirmed that stopping inhalers containing inhaled corticosteroids (ICS) can heighten flare-up risk and, for the first time, demonstrated that discontinuing long-acting muscarinic antagonist (LAMA) inhalers can also trigger these withdrawal effects.
Expert Commentary and Implications
Dr. Mathioudakis underscored the critical importance of communicating the risks associated with stopping treatment to patients, especially for those who discontinue without medical advice. Such communication is vital to help prevent avoidable flare-ups and subsequent hospital admissions.
"Communicating the risks of stopping treatment to patients, particularly for those who discontinue without medical advice, is important to help prevent avoidable flare-ups and hospital admissions."