COPD: Risks associated with long-term corticosteroid use

Long-term use of inhaled corticosteroids (ICS) in COPD patients triples the risk of pneumonia. These findings call into question the widespread prescription of ICS, which is thought to be useful in only 10% to 15% of COPD patients.The most recent recommendations for the treatment of chronic obstructive pulmonary disease (COPD) suggest long-acting bronchodilators as first-line therapy. ICS, on the other hand, are recommended only in cases of concomitant asthma, high eosinophil counts or in patients at high risk of exacerbation.Yet, inhaled corticosteroids remain part of the treatment plan for at least 60% of COPD patients, with ICS typically combined with a long-acting bronchodilator, either a long-acting beta-2 agonist inhaler (BALA) or a long-acting muscarinic antagonist inhaler (LAMA).Read: A comparison of two triple-therapy combination inhalers for COPDLong-term use of inhaled corticosteroids is not without risk. To compare their long-term effects (> 24 months) with their short-term effects (< 24 months), American researchers evaluated data from the electronic medical records of 621,739 individuals with COPD. The latter were then separated into two groups according to the time of diagnosis, either before or at the beginning of the observation period.“It is particularly important to focus on people with COPD, as ICS therapy is not considered a first-line treatment [according to the latest recommendations], but is often prescribed without any apparent indication,” said the study authors in the Annals of Family Medicine. Recurrent pneumoniaThe researchers noted whether any of these events had occurred during followup: diagnosis of type 2 diabetes, cataracts, pneumonia, osteoporosis or non-traumatic fracture. These events were significantly more frequent in long-term ICS users (HR = 2.65; 95% CI: 2.62-2.68). The risk of recurrent pneumonia was almost tripled (HR = 2.88; 95% CI, 2.62-3.16), and the risk of recurrent fractures increased by 77% (HR = 1.77; 95% CI, 1.42-2.21) when ICS use exceeded two years. These data were similar in both groups, irrespective of the time of diagnosis.Given these findings, the challenge is to balance the risks of long-term treatment with the limited benefits of corticosteroids for patients for whom ICS is not indicated.“It is important for clinicians to verify the need for ICS to treat COPD by assessing exacerbation frequency, total eosinophil count and BALA/AMLA treatment failure to ensure adequate exacerbation prevention before starting ICS therapy,” the researchers noted.

COPD: Risks associated with long-term corticosteroid use

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