Thorax

COPD patients face early flare risk after stopping LAMA or ICS

January 19, 2026

A post‑hoc analysis of the FLAME trial (NCT01782326) found that withdrawal of long‑acting muscarinic antagonists (LAMAs) or inhaled corticosteroids (ICSs) significantly elevates chronic obstructive pulmonary disease (COPD) exacerbation risk within the first three months. LAMA withdrawal led to up to a 2.2‑fold increase in moderate‑to‑severe exacerbations during the initial quarter (95% confidence interval, 1.2–4.1; p=0.001). ICS discontinuation produced an early rise in severe exacerbations (p=0.023), though moderate‑to‑severe rates were unchanged. ICS withdrawal effects were consistent regardless of baseline eosinophil count.

Clinical takeaway: Avoid sudden discontinuation of LAMA or ICS when possible; if stepping down therapy is necessary, closely monitor patients for the first 3 months due to elevated exacerbation risk.

Source:

Mathioudakis AG, et al. (2025, December 15). Thorax. Disproportionate increase in COPD exacerbation risk for 3 months after discontinuing LAMA or ICS: insights from the FLAME trial. https://pubmed.ncbi.nlm.nih.gov/41402044/