The COPERNICOS trial presented at the 2026 European Respiratory Society Congress suggests that inhaled corticosteroid (ICS) doses can be lowered in COPD patients whose blood eosinophil counts fall below a defined threshold, without a marked rise in severe flare‑ups. ICS therapy in COPD can increase risk of adverse events, which fuels concerns about long‑term overuse.
Eosinophil‑Guided Reduction Shows No Spike in Risks
Researchers randomized participants with chronic obstructive pulmonary disease to either continue standard triple therapy or switch to an eosinophil‑guided tapering protocol (EGT). The primary endpoint was the incidence of severe exacerbations; secondary outcomes included all‑cause mortality.
According to the abstract, patients in the EGT arm did not experience a statistically significant increase in severe exacerbations compared with those staying on triple therapy. Mortality rates were also comparable, although the trial did not meet formal non‑inferiority criteria.
“I think it used to be a drug that you would simply pick as soon as patients got sicker and not really think of what it was that made them so sick that you wanted to give them inhaled steroids,” said Jørgen Vestbo, MD, professor of respiratory medicine at Manchester University Hospital and a trial investigator.
Potential Shift in Prescribing Habits
Vestbo emphasized that the findings could prompt clinicians to reassess routine ICS use. He urged doctors to “Clinicians need to, first of all, accept that they have to measure the biomarker over time and be more willing to spend more time with their patients discussing why they’re on the drug and why they may not need to be on the drug.”
He also highlighted a patient‑side hurdle: “And then there’s the challenge for the patients to actually believe it is okay for me to take fewer drugs in the future, although I am breathless every day.” Discussions often include reviewing inhaler technique, checking adherence, and evaluating comorbidities that might amplify side‑effects, thereby supporting shared decision‑making.
While the trial focused on eosinophil counts, broader COPD management still relies on multiple factors, such as symptom burden and exacerbation history. The results do not suggest a blanket discontinuation of steroids, but rather a more personalized approach.
For readers seeking background on COPD, the Wikipedia entry provides a concise overview.
