There is no clear method for reducing or withdrawing ICS in people living with COPD. There are limited studies on this and their findings cannot be extrapolated and applied to the general UK COPD population. Some healthcare professionals may agree to trial dose reduction and/or withdrawal of ICS after discussion with the individual on a case-by-case basis, for example, in people prescribed them before current guidelines were published. This may be an option for people who have milder disease without asthmatic features or frequent exacerbations.

Practice points

• What are the main points you would discuss with someone who is about to start using a spacer for the first time?
• What procedures do you have in your place of work to ensure that steroid treatment cards are given to people who need them? Do all the members of your pharmacy team know how to identify people at risk?

Evaluate your learning

1. List five factors that increase the risk of someone experiencing an exacerbation of their COPD
2. How can you support people with COPD taking high-dose ICS to reduce their risk of side effects?
3. How would you address a patient’s concerns about the impact that inhalers can have on the environment?
4. What information should be included in a self-management plan for COPD?