Long-term inhaled corticosteroid therapy for COPD may have serious adverse effects

Exposure to inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD) in the long term may be detrimental to patients, being associated with elevated risks of diabetes, its progression and osteoporosis, as shown in a study.

The study used data from two large UK databases of patients (age ≥40 years) initiating ICS or long-acting bronchodilator (LABD) for COPD. Treatment was assessed in relation to the risk of diabetes onset (n=17,970), diabetes progression (n=804) or osteoporosis incidence (n=19,898).

All patients had available ≥1-year baseline and ≥2-year outcome data, with a median follow-up of 3.7–5.6 years per treatment group.

Conditional proportional hazards regression revealed that compared with LABD, ICS was associated with an increased risk of diabetes onset (adjusted hazard ratio [HR], 1.27, 95 percent confidence interval [CI], 1.07-1.50). There was no overall risk increase observed for diabetes progression (adjusted HR, 1.04, 95 percent CI, 0.87–1.25) and incident osteoporosis (adjusted HR, 1.13, 95 percent CI, 0.93–1.39).

However, a dose-response relationship for all three outcomes became apparent at mean ICS exposures of ≥500 µg/day (vs <250 µg/day, fluticasone propionate-equivalent). This pattern of association was not evident for cumulative ICS exposures.

The present data raise uncertainty with regard to the risk-benefit ratio for ICS in COPD. Hence, researchers stressed that careful selection of COPD therapies be practiced and that clinicians prescribe ICS only when indicated (within current GOLD strategy recommendations) and at the lowest possible doses.