INHALED corticosteroids (ICS) are commonly used in managing COPD, despite their risks. ICS therapy is not first-line treatment but is often prescribed, sometimes without clear indications. A recent study aimed to explore the long-term risks of ICS use, focusing on the development of adverse outcomes such as Type 2 diabetes (T2D), cataracts, pneumonia, osteoporosis, and fractures. The findings highlighted significant associations between long-term ICS use and these conditions, underlining the importance of considering the long-term side effects when prescribing ICS in COPD management.
The study involved a large cohort of individuals aged over 45 with COPD, sourced from an electronic health record (EHR) database. Two groups were identified: a prevalent cohort with a history of COPD (n=318,385) and an inception cohort diagnosed during the study period (n=209,062). Patients were classified based on their duration of ICS use: long-term (>24 months) and short-term (<4 months). The primary analysis compared the incidence of adverse outcomes across these two groups, assessing both a composite outcome (T2D, cataracts, pneumonia, osteoporosis, and fractures) and recurrent events like pneumonia and fractures.
Results showed that long-term ICS use was linked to a significantly higher risk of the composite outcome in both the prevalent (hazard ratio [HR] 2.65, 95% CI: 2.62–2.68; p<0.001) and inception (HR 2.60; 95% CI: 2.56–2.64; p<0.001) cohorts. Additionally, long-term ICS users had increased risks of recurrent pneumonia (HR 2.88; 95% CI: 2.62–3.16; p<0.001 in the prevalent cohort and HR 2.85; 95% CI: 2.53–3.22; p<0.001 in the inception cohort) and fractures (HR 1.77; 95% CI: 1.42–2.21; p<0.001 in the prevalent cohort and HR 1.57; 95% CI: 1.20–2.06; p<0.001 in the inception cohort). Sensitivity analyses further confirmed the robustness of these findings, regardless of medication adjustments or asthma comorbidity.
This study confirms that long-term ICS use in COPD patients significantly increases the risk of several adverse health outcomes. However, the authors do note limitations, such as the reliance on EHR data, which does not guarantee precise information on treatment adherence or specific drug dosages. Additionally, the lack of data on COPD severity may limit the generalizability of the results. Despite these limitations, the findings suggest that long-term ICS therapy in COPD requires careful consideration to avoid unnecessary harm.
Reference
Pace WD et al. Adverse Outcomes Associated With Inhaled Corticosteroid Use in Individuals With Chronic Obstructive Pulmonary Disease. Ann Fam Med. 2025;23(2):127-35
