Corticosteroids for Chronic Obstructive Pulmonary Disease (COPD)
Examples
Pill or liquid form (oral)
|
| methylprednisolone | Medrol |
| prednisolone | Prelone |
| prednisone | |
Inhaled form
|
| beclomethasone | QVAR |
| budesonide | Pulmicort Flexhaler, Rhinocort |
| flunisolide | AeroBid |
| fluticasone | Flovent |
| mometasone | Asmanex Twisthaler |
| triamcinolone | Azmacort |
Corticosteroid and beta2-agonist combination
|
| budesonide and formoterol | Symbicort |
| fluticasone and salmeterol | Advair |
Inhaled corticosteroids are usually delivered using a
metered-dose
inhaler (MDI) but are also often available for dry
powder inhalers (DPI).
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]).5
Research on inhaled
corticosteroids:
- Suggests that for some people they reduce the
frequency of COPD exacerbations compared to a
placebo.3, 7
- Reports
conflicting results on whether they improve lung function.7, 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.1, 2
- Fewer COPD exacerbations compared to a
placebo.1, 7
Combining a corticosteroid with a beta2-agonist and an
anticholinergic improved:6
- 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.6
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 salmeterol, 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.
Dry powder inhalers 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.3
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.
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
References
Citations
- Calverley P, et al. (2003). Combined salmeterol and
fluticasone in the treatment of chronic obstructive pulmonary disease: A
randomised controlled trial. Lancet, 361:
449–456.
- Hanania NA, et al. (2003). The efficacy and safety of
fluticasone propionate (250 micrograms)/salmeterol (50 micrograms) combined in
the Diskus Inhaler for the treatment of COPD. Chest,
124: 834–843.
- Alsaeedi A, et al. (2002). The effects of inhaled
corticosteroids in chronic obstructive pulmonary disease: A systematic review
of randomized placebo-controlled trials. American Journal of Medicine, 113: 59–65.
- Highland KB, et al. (2003). Long-term effects of
inhaled corticosteroids on FEV1 in patients with chronic obstructive pulmonary
disease. Annals of Internal Medicine, 138:
969–973.
- Singh JM, et al. (2002). Corticosteroid therapy for
patients with acute exacerbations of chronic obstructive pulmonary disease.
Archives of Internal Medicine, 162:
2527–2536.
- Aaron SD, et al. (2007). Tiotropium in combination
with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic
obstructive pulmonary disease. Annals of Internal Medicine, 146(8): 545–555.
- Kerstjens H, et al. (2005). Chronic
obstructive pulmonary disease. Clinical Evidence (13):
1923-1947.
- Global Initiative for Chronic Obstructive
Lung Disease (GOLD) (2005). Executive summary (updated 2005). In
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online:
http://www.goldcopd.com/GuidelinesResources.asp?I1=2&I2=0.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Caroline S. Rhoads, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | Ken Y. Yoneda, MD - Pulmonology |
|---|
| Last Revised | May 4, 2010 |
|---|
Last Revised:
May 4, 2010
Calverley P, et al. (2003). Combined salmeterol and
fluticasone in the treatment of chronic obstructive pulmonary disease: A
randomised controlled trial. Lancet, 361:
449–456.
Hanania NA, et al. (2003). The efficacy and safety of
fluticasone propionate (250 micrograms)/salmeterol (50 micrograms) combined in
the Diskus Inhaler for the treatment of COPD. Chest,
124: 834–843.
Alsaeedi A, et al. (2002). The effects of inhaled
corticosteroids in chronic obstructive pulmonary disease: A systematic review
of randomized placebo-controlled trials. American Journal of Medicine, 113: 59–65.
Highland KB, et al. (2003). Long-term effects of
inhaled corticosteroids on FEV1 in patients with chronic obstructive pulmonary
disease. Annals of Internal Medicine, 138:
969–973.
Singh JM, et al. (2002). Corticosteroid therapy for
patients with acute exacerbations of chronic obstructive pulmonary disease.
Archives of Internal Medicine, 162:
2527–2536.
Aaron SD, et al. (2007). Tiotropium in combination
with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic
obstructive pulmonary disease. Annals of Internal Medicine, 146(8): 545–555.
Kerstjens H, et al. (2005). Chronic
obstructive pulmonary disease. Clinical Evidence (13):
1923-1947.
Global Initiative for Chronic Obstructive
Lung Disease (GOLD) (2005). Executive summary (updated 2005). In
Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Available online:
http://www.goldcopd.com/GuidelinesResources.asp?I1=2&I2=0.
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