Observational studyPloS one2013
Overtreatment of COPD with inhaled corticosteroids--implications for safety and costs: cross-sectional observational study.
Observational study in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
70 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease.The Cochrane database of systematic reviews · 2023Pooled it
- Blood eosinophil count, a marker of inhaled corticosteroid effectiveness in preventing COPD exacerbations in post-hoc RCT and observational studies: systematic review and meta-analysis.Respiratory research · 2020Pooled it
- Long-acting muscarinic antagonist (LAMA) plus long-acting beta-agonist (LABA) versus LABA plus inhaled corticosteroid (ICS) for stable chronic obstructive pulmonary disease (COPD).The Cochrane database of systematic reviews · 2017Pooled it
- The Pharmacological Treatment of Chronic Obstructive Pulmonary Disease.Deutsches Arzteblatt international · 2016Pooled it
- Withdrawal of inhaled corticosteroids from patients with COPD with mild or moderate airflow limitation in primary care: a feasibility randomised trial.BMJ open respiratory research · 2022Trial
- C-reactive protein point-of-care testing for safely reducing antibiotics for acute exacerbations of chronic obstructive pulmonary disease: the PACE RCT.Health technology assessment (Winchester, England) · 2020Trial
- Trial
- Adherence to Pharmacological Management Guidelines for Stable Chronic Obstructive Lung Disease.Tuberculosis and respiratory diseases · 2025Article
- The effect of a post-bronchodilator FEVRespiratory research · 2025Article
- A service evaluation following the implementation of computer guided consultation software to support primary care reviews for chronic obstructive pulmonary disease.NPJ primary care respiratory medicine · 2025Article
- Single-Inhaler Triple Therapy in Primary Care Across Europe: Expert Panel Consensus on the Consequences of Payer-Driven Access Rules and Call to Action.International journal of chronic obstructive pulmonary disease · 2025Review
- Comparison of Infection Risks Between Various Inhaled and Intranasal Corticosteroids: A Pharmacovigilance Analysis Based on the FAERS Database.International journal of chronic obstructive pulmonary disease · 2024Article
- Chronic Obstructive Pulmonary Disease Overdiagnosis and Overtreatment: A Meta-Analysis.Journal of clinical medicine · 2023Review
- Rational use of inhaled corticosteroids for the treatment of COPD.NPJ primary care respiratory medicine · 2023Review
- Practical Recommendations for a Selection of Inhaled Corticosteroids in COPD: A Composite ICO Chart.Biomolecules · 2023Review
- The Impact of Inhaled Corticosteroids on the Prognosis of Chronic Obstructive Pulmonary Disease.International journal of chronic obstructive pulmonary disease · 2023Article
- A descriptive cohort study of withdrawal from inhaled corticosteroids in COPD patients.NPJ primary care respiratory medicine · 2022Article
- Blood eosinophils to guide inhaled maintenance therapy in a primary care COPD population.ERJ open research · 2022Article
- Article
- Efficacy and Safety of Re Du Ning Injection for Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.Evidence-based complementary and alternative medicine : eCAM · 2022Review
10 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
introductionCombined inhaled long-acting beta-agonists and corticosteroids (LABA+ICS) are costly. They are recommended in severe or very severe chronic obstructive pulmonary disease (COPD). They should not be prescribed in mild or moderate disease. In COPD ICS are associated with side-effects including risk of pneumonia. We quantified appropriateness of prescribing and examined the risks and costs associated with overuse.
methodsData were extracted from the electronic and paper records of 41 London general practices (population 310,775) including spirometry, medications and exacerbations. We classified severity, assessed appropriateness of prescribing using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for 2009, and performed a sensitivity analysis using the broader recommendations of the 2011 revision.
results3537 patients had a diagnosis of COPD. Spirometry was recorded for 2458(69%). 709(29%) did not meet GOLD criteria. 1749(49%) with confirmed COPD were analysed: 8.6% under-treated, 38% over-treated. Over-prescription of ICS in GOLD stage I or II (n=403, 38%) and in GOLD III or IV without exacerbations (n=231, 33.6%) was common. An estimated 12 cases (95%CI 7-19) annually of serious pneumonia were likely among 897 inappropriately treated. 535 cases of overtreatment involved LABA+ICS with a mean per patient cost of £553.56/year (€650.03). Using the broader indications for ICS in the 2011 revised GOLD guideline 25% were still classified as over-treated. The estimated risk of 15 cases of pneumonia (95%CI 8-22) in 1074 patients currently receiving ICS would rise by 20% to 18 (95%CI 9.8-26.7) in 1305 patients prescribed ICS if all with GOLD grade 3 and 4 received LABA+ICS.
conclusionOver-prescription of ICS in confirmed COPD was widespread with considerable potential for harm. In COPD where treatment is often escalated in the hope of easing the burden of disease clinicians should consider both the risks and benefits of treatment and the costs where the benefits are unproven.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.