Long-term inhaled corticosteroids linked to increased health risks in COPD patients

Background and goal: Inhaled corticosteroids (ICS) are commonly prescribed for chronic obstructive pulmonary disease (COPD), but not recommended as first-line treatment unless patients have asthma/COPD overlap or frequent exacerbations. This study examined whether long-term ICS use (more than two years) increases the risk of serious health conditions compared with short-term use (less than 4 months).

Study approach: Researchers analyzed electronic health records from over 20 million patients, focusing on individuals aged 45 and older with a COPD diagnosis. They created two groups: a prevalent cohort (patients diagnosed with COPD at any time) and an inception cohort (patients newly diagnosed with COPD). Using propensity score matching, they compared long-term ICS users with those with short-term use. Researchers examined the risk of developing both a composite outcome (any of five major conditions) and individual health outcomes for over 500,000 people.

Main results: 

Overall Risk (Composite Outcome)

• Compared with those using ICS for a short time, long-term ICS users were more than twice as likely to develop at least one of the following conditions:

  • Type 2 diabetes

  • Cataracts

  • Pneumonia

  • Osteoporosis

  • Nontraumatic fractures

• Prevalent cohort (all COPD patients): risk was 165% higher Inception cohort (newly diagnosed COPD patients): risk was 160% higher Among newly diagnosed COPD patients, 1 in 5 long-term ICS users developed at least one of these conditions.

Recurrent Cases

• Some conditions were also analyzed for recurrent cases (meaning patients who developed them more than once):

• People on long-term ICS were nearly three times as likely to have repeated cases of pneumonia Fractures were also more likely to happen again

Individual Outcomes

Diabetes, cataracts, pneumonia, osteoporosis, and fractures were also more common in long-term ICS users before being combined into the composite outcome.

Why It Matters: Many patients with COPD are prescribed ICS even when not medically necessary, exposing them to serious long-term risks.