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The WISDOM randomized trial tested a clinically important question: can inhaled corticosteroids be withdrawn from severe COPD patients who are already receiving dual long-acting bronchodilation? Patients underwent a stepwise reduction in inhaled glucocorticoid dose while continuing tiotropium and salmeterol. The primary outcome was the time to first moderate or severe exacerbation over a 12-month period. Gradual withdrawal did not meet criteria for a clinically important increase in exacerbation risk compared with continued triple therapy, although a modest additional decline in FEV1 occurred during withdrawal. The practical lesson is not that inhaled corticosteroids should routinely be stopped. Rather, the study supports individualized reassessment of the need for ICS after optimizing bronchodilation, especially when the indication for continued ICS is uncertain. In the NAPCON context, this fits directly with the COPD session's focus on moving from guideline strategy to real-world treatment decisions and on making the ICS choice more phenotype- and risk-based. Clinicians should still consider exacerbation history, eosinophil profile, asthma features, prior response and pneumonia risk before stepping down.
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The WISDOM randomized trial tested a clinically important question: can inhaled corticosteroids be withdrawn from severe COPD patients who are already receiving dual long-acting bronchodilation? Patients underwent a stepwise reduction in inhaled glucocorticoid dose while continuing tiotropium and salmeterol. The primary outcome was the time to first moderate or severe exacerbation over a 12-month period. Gradual withdrawal did not meet criteria for a clinically important increase in exacerbation risk compared with continued triple therapy, although a modest additional decline in FEV1 occurred during withdrawal. The practical lesson is not that inhaled corticosteroids should routinely be stopped. Rather, the study supports individualized reassessment of the need for ICS after optimizing bronchodilation, especially when the indication for continued ICS is uncertain. In the NAPCON context, this fits directly with the COPD session's focus on moving from guideline strategy to real-world treatment decisions and on making the ICS choice more phenotype- and risk-based. Clinicians should still consider exacerbation history, eosinophil profile, asthma features, prior response and pneumonia risk before stepping down.
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