{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:44:14Z","timestamp":1791967454102,"version":"4.3.4"},"reference-count":44,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT, South Korea","doi-asserted-by":"publisher","award":["RS\u20102025\u201000519997"],"award-info":[{"award-number":["RS\u20102025\u201000519997"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Respirology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>In chronic obstructive pulmonary disease (COPD), evidence supporting escalation to inhaled corticosteroid (ICS)\u2010containing therapy after single moderate exacerbation in patients receiving dual bronchodilator therapy remains inconsistent. We aimed to evaluate whether the clinical benefit of ICS escalation differs according to the treatment phenotype of moderate exacerbations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the Korean National Health Insurance Service database, we identified ICS\u2010na\u00efve patients with COPD initiating long\u2010acting muscarinic antagonist (LAMA)\/long\u2010acting \u03b22\u2010agonist (LABA) therapy. Sequential target trial emulations were conducted among patients who experienced one moderate exacerbation while on LAMA\/LABA. Exacerbations were classified as antibiotic\u2010treated (without systemic corticosteroids) or systemic corticosteroid\u2010treated (with or without antibiotics). Outcomes were compared between ICS escalation and LAMA\/LABA continuation groups\u00a0using propensity score matching.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 94,938 patients who initiated LAMA\/LABA therapy, treatment persistence remained high, with over 60% maintaining dual therapy at 6\u2009years, despite a marked decline in exacerbation\u2010free survival. In matched analyses, ICS escalation after single antibiotic\u2010treated exacerbations was not associated with reduced subsequent exacerbation risk. In contrast, among patients with steroid\u2010treated moderate exacerbations, continuation of LAMA\/LABA was associated with a higher risk of exacerbations (HR 1.18, 95% CI 1.12\u20131.23), compared with escalation to ICS\u2010containing therapy. Findings were consistent across subgroups defined by exacerbation history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large real\u2010world COPD cohort, the benefit of ICS escalation after single moderate exacerbation varied by exacerbation treatment phenotype. Steroid\u2010treated events were associated with a reduced subsequent exacerbation with ICS escalation, whereas antibiotic\u2010treated events did not confer additional benefit from ICS, supporting a more precise approach to ICS escalation beyond exacerbation frequency alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/resp.70300","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:02:17Z","timestamp":1787835737000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Inhaled Corticosteroid Escalation After a Single Moderate Exacerbation in\n                    <scp>COPD<\/scp>\n                    : Differential Benefit by Exacerbation Subtype"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3164-889X","authenticated-orcid":false,"given":"Sun Hye","family":"Shin","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihye","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Design and Evaluation, SAIHST Sungkyunkwan University  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1589-4142","authenticated-orcid":false,"given":"Ji Ye","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine Severance Hospital, Yonsei University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9081-0266","authenticated-orcid":false,"given":"Juhee","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Design and Evaluation, SAIHST Sungkyunkwan University  Seoul Korea"},{"name":"Center for Clinical Epidemiology Samsung Medical Center  Seoul South Korea"},{"name":"Digital Innovation Center Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Singh","sequence":"additional","affiliation":[{"name":"University of Manchester, Manchester University NHS Foundation Trust  Manchester UK"},{"name":"Medicines Evaluation Unit, an IQVIA Business  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0244-7714","authenticated-orcid":false,"given":"Danbee","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Clinical Research Design and Evaluation, SAIHST Sungkyunkwan University  Seoul Korea"},{"name":"Center for Clinical Epidemiology Samsung Medical Center  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5937-9671","authenticated-orcid":false,"given":"Hye Yun","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul Korea"},{"name":"Department of Clinical Research Design and Evaluation, SAIHST Sungkyunkwan University  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"\u201cThe Global Strategy for Prevention Diagnosis and Management of COPD: 2026 Report\u201d https:\/\/goldcopd.org\/2026\u2010gold\u2010report\u2010and\u2010pocket\u2010guide\/ accessed January 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