Long-term use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease could be linked to significantly higher risks of several health conditions, according to a large study of electronic health records.
Patients who used inhaled corticosteroids (ICS) for more than 24 months had a higher likelihood of developing type 2 diabetes, pneumonia, cataracts, osteoporosis, and nontraumatic fractures compared with those who used ICS for fewer than 4 months.
In the study, investigators analyzed data from more than 500,000 patients with chronic obstructive pulmonary disease (COPD). Two cohorts were examined: a prevalent group of 318,385 patients with preexisting COPD at database entry and an inception group of 209,062 patients newly diagnosed during the study period. To isolate the effects of ICS in COPD, the investigators excluded patients with asthma and other severe conditions.
In the inception group, 29.41% of long-term ICS users developed at least one of the specified health outcomes compared with 9.15% of short-term users. This corresponded to a number needed to harm of 5.
“Long-term ICS use for COPD is associated with significantly greater rates of the composite outcome of type 2 diabetes, cataracts, pneumonia, osteoporosis, and nontraumatic fracture; recurrent pneumonia; and recurrent fracture,” said lead study author Wilson D. Pace, MD, of the DARTNet Institute, and colleagues. The investigators showed a consistent pattern of increased risk across all individual outcomes.
Pneumonia had one of the strongest associations. Long-term ICS users were nearly three times more likely to experience recurrent pneumonia compared with short-term users. Risk of recurrent fractures was also elevated, with a 77% increase among long-term users.
The investigators used propensity score matching to balance differences in age, sex, smoking history, race, and overall health status. The findings remained consistent after adjustment for these variables.
Although ICS can benefit some patients, current clinical guidelines recommend its use primarily among those with frequent exacerbations and high eosinophil counts or with asthma-like features. The investigators noted that ICS is often prescribed outside these indications, potentially exposing patients to unnecessary risks.
Many participants in the study may have been receiving ICS without a clear clinical indication, raising concerns about prescribing practices and long-term safety awareness.
While the adverse outcomes studied—type 2 diabetes, cataracts, fractures, pneumonia, and osteoporosis—are recognized complications of systemic corticosteroids, this study is one of the largest to demonstrate similar risks associated with inhaled steroids in a real-world COPD population.
The investigators emphasized the need to reevaluate ICS use in COPD management. They advised clinicians to confirm the indication for ICS prior to initiating therapy and to monitor patients for adverse effects during prolonged treatment.
They concluded that these findings supported more cautious use of ICS in patients with COPD, particularly those without asthma or frequent exacerbations.
Full disclosures can be found in the published study.
Source: Annals of Family Medicine