Inhaled corticosteroids (ICS) have revolutionised asthma control but have a lesser role in patients with chronic obstructive pulmonary disease (COPD) and no asthma. ICS increase risk of pneumonia and other risks in patients with COPD, and long-acting bronchodilators are just as effective in many. Nevertheless, some subgroups may benefit from ICS.
- Inhaled corticosteroids (ICS) have revolutionised asthma control, but their use in patients with chronic obstructive pulmonary disease (COPD) is not as definitive.
- Long-acting bronchodilators help control symptoms and reduce the risk of exacerbations for most patients with COPD.
- Adding ICS to dual long-acting bronchodilators reduces exacerbations in patients with a history of recurrent exacerbations or coexisting asthma, especially if blood eosinophil counts are high (more than 0.35 x 109 cells/L).
- However, use of ICS by patients with COPD increases the risk of pneumonia and some metabolic consequences.
- ICS should not be used in patients with mild-to-moderate COPD; if already prescribed in these patients they can be judiciously withdrawn.