Corticosteroids for chronic obstructive pulmonary disease (COPD)

Examples

Pill or liquid form (oral)

Generic Name	Brand Name
methylprednisolone	Medrol, Solu-Medrol
prednisolone	Prelone
prednisone

Inhaled form

Generic Name	Brand Name
beclomethasone dipropionate	QVAR 40, QVAR 80
budesonide	Pulmicort Turbuhaler, Pulmicort Flexhaler, Rhinocort
flunisolide	AeroBid
fluticasone propionate	Flovent Diskus, Flovent HFA
mometasone furoate	Asmanex Twisthaler
triamcinolone acetonide	Azmacort

Corticosteroid and beta2-agonist combination

Generic Name	Brand Name
fluticasone propionate and salmeterol xinafoate	Advair Diskus
budesonide and formoterol	Symbicort

Inhaled corticosteroids are usually delivered using a metered-dose inhaler (MDI) but are also often available for dry powder inhalers (DPI) such as Diskus or Turbuhaler.

How It Works

Corticosteroids decrease inflammation in the airways (reducing swelling and mucus production), making breathing easier.

Why It Is Used

Oral corticosteroids may be used to treat chronic obstructive pulmonary disease (COPD) when symptoms rapidly get worse (COPD exacerbation), especially when there is increased mucus production.

Inhaled corticosteroids may be used to treat stable symptoms of COPD or symptoms that are slowly getting worse. Inhaled corticosteroids may decrease the number of COPD exacerbations in people with severe COPD, particularly those with chronic bronchitis and frequent exacerbations.

Corticosteroids may be useful for people who have asthma as a component of their disease.

How Well It Works

Research results on oral corticosteroids for COPD exacerbations show that:

• They improve lung function, reduce the amount of time in the hospital, and reduce the incidence of treatment failure (return to the hospital, death, or the need for a tube inserted through the mouth or nose and into the chest to deliver oxygen [endotracheal intubation]).¹

Research on inhaled corticosteroids:

• Suggests that for some people they reduce the frequency of COPD exacerbations compared to a placebo.²
• Reports conflicting results on whether they improve lung function.^{3, 4}

Studies report that combining an inhaled corticosteroid with a long-acting beta2-agonist resulted in:

• Improved lung function and improved shortness of breath and less use of relief medicine compared to a placebo and compared to either medicine used alone.^{5, 6}
• Fewer COPD exacerbations compared to a placebo.^{5, 3}

Combining a corticosteroid with a beta2-agonist and an anticholinergic improved:⁷

• Lung function.
• Quality of life.
• The number of hospital visits.

But people who used fluticasone combined with a beta2-agonist were more likely to get pneumonia.⁷

Side Effects

The possibility of side effects increases as the dose of the medicine increases. Side effects are less likely to occur when you use the inhaled form of the medicine.

Oral corticosteroids (short-term use)

Side effects of short-term use of oral corticosteroids include:

• Weight gain and fluid retention.
• Mood changes.
• Increased blood sugar level, which may lead to a type of diabetes caused by the medicine (secondary diabetes). If you already have diabetes, it may make the diabetes harder to control.
• High blood pressure.

Oral corticosteroids (long-term use)

Side effects of long-term use of oral corticosteroids include:

• Osteoporosis (bone weakening), which is common. Destruction of bone from loss of blood supply is rare.
• Recurrent infections.
• A cloudy area in the lens of the eye (cataracts).
• Thin, fragile skin that bruises easily.
• Increased risk for sores in the stomach (ulcers).

Inhaled steroids

Side effects of inhaled steroids include:

• Sore mouth or sore throat.
• Voice changes, such as hoarseness.
• Heavy growth of a fungus in the mouth, throat, or esophagus (thrush).

The U.S. Food and Drug Administration (FDA) has reported that salmeterol may make breathing more difficult. If your wheezing gets worse after taking this medicine (Advair Diskus), call your doctor right away.

Using a device called a spacer with your metered-dose inhaler and rinsing your mouth with water and spitting the water out after inhaling should reduce these side effects.

Pulmicort Turbuhaler, Advair Diskus, Asmanex Twisthaler, and QVAR are not used with a spacer.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Inhaled corticosteroids are preferred to oral corticosteroids for long-term treatment of COPD because they cause fewer side effects. But low-dose inhaled steroids do not always work as well as high-dose oral steroids.

Long-term treatment with oral corticosteroids is not recommended.⁸ Although long-term treatment with inhaled corticosteroids reduces the frequency of COPD exacerbations in some people, the long-term risks and whether the benefit is worth the risks of long-term treatment is not known.²

It is not possible to predict who will improve with corticosteroid therapy. Lung function tests (spirometry) can be done before and after using the medicine, to learn if it has helped.

Most doctors recommend that everyone using an inhaler also use a spacer. Use of a spacer is especially important when using an inhaler containing a steroid medicine. But you should not use a dry powder inhaler (DPI) with a spacer.

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Author:	Maria G. Essig, MS, ELS	Last Updated: May 8, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Ken Y. Yoneda, MD - Pulmonology
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