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Open Access Con: Inhaled corticosteroids should not be used in patients with chronic obstructive pulmonary disease

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Inhaled corticosteroids (ICS) are frequently used in the treatment of chronic obstructive pulmonary disease (COPD). However, recent evidence indicates that the routine use of ICS in patients with COPD should be re-examined.


(1) To review the evidence about the risks of ICS in patients with COPD, and (2) to provide considerations for patients in whom ICS should not be used.


A thorough review of the key literature that evaluates the risks of the use of ICS in patients with COPD.


The data that support the use of ICS as part of combination therapy in patients with COPD showed that, in some patients, these ICS can reduce exacerbations, improve lung function, and lessen breathlessness. However, there is a substantial body of evidence that demonstrates the increased risk of pneumonia, cataracts, osteoporosis, adrenal insufficiency, and other complications from the long-term use of ICS. This mounting collection of evidence of adverse events as a result of ICS is a reason to be hesitant about prescribing these medications in patients with COPD.


The risks of ICS must be carefully weighed against the benefits when ICS are used as part of a long-term inhaled therapy regimen for patients with COPD. Prescribers should carefully consider the utility of these medications and consider stopping them when no longer indicated so to minimize the risks that patients are exposed to as a result of ICS.
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Keywords: COPD; cataracts; dyspnea; exacerbations; inhaled corticosteroids; long-acting beta agonists; lung function; osteoporosis; pneumonia; quality of life

Document Type: Research Article

Affiliations: 1: From the Department of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, Colorado, and 2: Department of Medicine, National Jewish Health; Denver, Colorado

Publication date: December 1, 2019

More about this publication?
  • The Journal of Precision Respiratory Medicine (JPRM) is a peer reviewed publication dedicated to distributing timely information regarding cutting edge advancements in the knowledge and practice of respiratory medicine. Its primary readership extends to all medical providers with an interest in respiratory diseases.

    The incorporation of the term, 'precision medicine' in its title serves to direct the journal's focus on this revolutionary approach to disease prevention and treatment that takes into account the individual differences which result from the interplay of lifestyle, environment and human biology/genetics.

    JPRM seeks to publish articles characterized by both a predominant clinical focus and by having the potential to directly impact the quality of patient care. JPRM welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Pulmonary Conference (EPC) JPRM will publish content from EPC poster sessions as well as review articles derived from EPC lectures.

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