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Warning over early prescribing of inhaled steroids for COPD patients

By Mark Pownall

GPs have been warned against prescribing inhaled steroids too early in patients with COPD because of the associated risk of pneumonia.

The government's drug safety watchdog, the Medicines and Healthcare Regulatory Agency, suggests steroids ‘are being introduced earlier than current guidelines recommend'.

It says combining LABAs with inhaled steroids has no proven significant benefits in mild disease, but that steroids significantly increase the risk of pneumonia.

NICE guidance, currently under review, says inhaled steroids should be added for severe disease with an FEV1 under 50% and where there are repeated exacerbations.

Combination is better than monotherapy in all trials that have compared the two treat-ments, but the benefit is limited.

Inhaled steroids should be limited to when COPD progresses to severe disease, and never on their own, the MHRA says.

Dr Steve Holmes, a GP in Shepton Mallet, Somerset and education lead of the General Practice Airways Group said the advice was ‘very sensible'.

‘We need to question the concept of automatically putting COPD patients on inhaled steroids. It is a legacy of old treatment ideas.'

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