Under what condition should inhaled corticosteroids (ICS) be added to COPD therapy?

Inhaled corticosteroids (ICS) are often added to the treatment regimen for Chronic Obstructive Pulmonary Disease (COPD) in specific circumstances to effectively manage the condition and prevent exacerbations. One of the key indicators for adding ICS is when eosinophil counts exceed a certain threshold, typically greater than 300 cells per microliter. Elevated eosinophil levels can indicate an inflammatory response that may be exacerbated by COPD, suggesting that the disease might be driven by airway inflammation similar to that seen in asthma.

In such cases, the inflammatory component can lead to an increased risk of exacerbations, and the use of ICS can help reduce this inflammation, improving overall lung function and quality of life for the patient. This strategy has been backed by clinical studies demonstrating that patients with higher eosinophil counts benefit from the addition of ICS in terms of reduced exacerbation rates.

The other conditions listed, such as low oxygen saturation or a history of asthma, are important factors in the management of COPD but do not directly correlate with the decision to initiate ICS therapy in the same way that elevated eosinophil levels do. Frequent upper respiratory infections, while they may indicate a need for management adjustments, are not a primary indication for