Rethinking Long-Term Inhaled Steroid Use in COPD: A Closer Look at the Risks

For individuals living with chronic obstructive pulmonary disease (COPD), inhaled corticosteroids (ICS) have long been a cornerstone of treatment. However, a recent study published in the Annals of Family Medicine suggests that extended use of these medications may come with significant risks.

Led by Dr. Wilson D. Pace of the DARTNet Institute in Aurora, Colorado, researchers analyzed electronic health records from over half a million patients aged 45 and older to assess the long-term effects of ICS therapy. Two separate cohorts were examined: one including patients diagnosed with COPD at any time during the study period (318,385 individuals) and another consisting of those diagnosed only after entering the database (209,062 individuals).

The findings raised concerns. Patients who used ICS for more than 24 months had a significantly higher likelihood of developing serious health complications—including diabetes, cataracts, osteoporosis, pneumonia, and bone fractures—compared to those with short-term ICS exposure of less than four months. The study calculated a hazard ratio of 2.65 for the first cohort and 2.60 for the second, indicating a more than twofold increase in risk. For recurrent pneumonia and fractures specifically, the risk was even higher, with hazard ratios reaching 2.88 and 1.77, respectively.

Perhaps most striking was the absolute risk difference: In the inception cohort, the likelihood of experiencing one or more of these adverse outcomes rose by over 20%, with a number needed to harm (NNH) of just five. This means that for every five patients treated long-term with ICS, at least one will likely suffer a serious complication.

Given these findings, the study authors urge physicians to weigh the risks and benefits carefully before prescribing long-term ICS therapy for COPD patients. “The clinical use of and indications for ICS therapy in COPD should be carefully considered for each individual before initiation of long-term ICS therapy,” the researchers concluded.

It’s worth noting that the study received funding from pharmaceutical company Boehringer Ingelheim, and several authors disclosed ties to the industry. While the results emphasize the need for cautious prescribing, further independent studies may help clarify the full impact of prolonged ICS use.

For COPD patients and their doctors, this research underscores the importance of personalized treatment plans, considering both the potential benefits and long-term risks of inhaled corticosteroids.