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Marzuki NM, Jaeb MZM, Ban A, Ismail AI, Ali IAH, Razali NM, Samsudin A, Nasaruddin MZ, Rahman RA, Zim MAM, Kassim R, Lam YF, Tarekh NA, Ibrahim A, Kapse SV. Personalised management of Chronic Obstructive Pulmonary Disease (COPD): Malaysian consensus algorithm for appropriate use of inhaled corticosteroid (ICS) in COPD patients. Med J Malaysia 2020; 75:717-721. [PMID: 33219183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- N M Marzuki
- Institut Perubatan Respiratori, Kuala Lumpur, Malaysia
| | - M Z M Jaeb
- Hospital Raja Perempuan Zainab II (HRPZ II), Department of Medicine, Kota Bharu, Kelantan, Malaysia
| | - A Ban
- Universiti Kebangsaan Malaysia Medical Centre, Department of Medicine, Kuala Lumpur, Malaysia
| | - A I Ismail
- Universiti Teknologi MARA, Faculty of Medicine, Selangor, Malaysia
| | - I A H Ali
- Hospital Pulau Pinang, Department of Respiratory Medicine, Pulau Pinang, Malaysia
| | - N M Razali
- Hospital Sultanah Nur Zahirah, Department of Respiratory Medicine, Kuala Terengganu, Terengganu, Malaysia
| | - A Samsudin
- Hospital Sultanah Nur Zahirah, Department of Respiratory Medicine, Kuala Terengganu, Terengganu, Malaysia
| | - M Z Nasaruddin
- Hospital Serdang, Department of Respiratory Medicine, Selangor, Malaysia
| | - R A Rahman
- Department of Respiratory Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - M A M Zim
- Universiti Teknologi MARA, Faculty of Medicine, UiTM Selayang campus, Selangor, Malaysia
| | - R Kassim
- Hospital Sultanah Bahiyah, Department of Respiratory Medicine, Alor Setar, Kedah, Malaysia
| | - Y F Lam
- Hospital Raja Permaisuri Bainun, Department of Respiratory Medicine, Ipoh, Perak, Malaysia
| | - N A Tarekh
- Department of Respiratory Medicine, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | - A Ibrahim
- Hospital Tengku Ampuan Afzan, Department of Respiratory Medicine, Kuantan, Pahang, Malaysia
| | - S V Kapse
- Novartis Corporation (Malaysia) Sdn Bhd, Medical Affairs Department, Petaling Jaya, Selangor, Malaysia.
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