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

Background:

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.

Objectives:

(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.

Methods:

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

Results:

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.

Conclusion:

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.