Corticosteroids

Corticosteroids are a type of medicine commonly used as part of a treatment plan for chronic obstructive pulmonary disease (COPD). Corticosteroids are also called steroids or glucocorticosteroids. They are similar to hormones produced naturally in the adrenal glands, which sit on top of the kidneys. Corticosteroids are not the same as anabolic steroids, which are substances sometimes used by bodybuilders that can have dangerous side effects.^1,2

What are steroids and how do they treat COPD?

People with COPD have airways that are irritated and swollen, which can make it hard to breathe. Corticosteroids reduce inflammation, so they can help to reduce the amount of swelling in the airways and make breathing easier.²

Not everyone with COPD needs treatment with corticosteroids, because other types of medicines can control their symptoms. But some patients need steroids as well as other medicines, especially if their symptoms are more severe. These patients may need to use steroids as part of long-term maintenance therapy for COPD. This means that they take them on a daily basis to manage their everyday symptoms.^1,2

Acute exacerbations, which are also called COPD attacks or flare-ups, happen when COPD symptoms suddenly get worse. People who have a moderate or severe COPD flare-up may need corticosteroid treatment to help bring the attack under control and keep it from getting worse.^1,2

Corticosteroids for COPD may be taken by inhalation or in pill form by mouth.

Inhaled steroids for COPD

Corticosteroids for treating COPD are usually inhaled, if possible. This allows most of the medication to go directly into the lungs, where it is most needed. It also avoids some serious side effects that can happen from taking corticosteroids by mouth.^1,2

Patients can take an inhaled steroid by breathing it in through an inhaler or nebulizer. These inhaled corticosteroids include:

• Qvar^® (beclomethasone dipropionate HFA)
• Beclovent^® (beclomethasone dipropionate)
• Pulmicort^® (budesonide)
• AeroBid^® (flunisolide)
• Flovent^® (fluticasone propionate)
• Azmacort^® (triamcinolone acetonide)

For people with a more advanced stage of COPD, inhaled steroids can help them to:

• Manage COPD symptoms
• Have improved lung function
• Have a better quality of life
• Reduce the number of COPD flare-ups that they have^1,2

However, treatment with corticosteroids will not keep the disease from getting worse over time.

Oral steroids for COPD

It can take days or weeks of treatment for inhaled steroids to start working at full strength in a person's body. Some patients need treatment that takes effect more quickly than that. For this reason, some people need to take steroids by mouth, in pill, tablet or liquid form.^1,2

Oral steroids also come in higher doses. This is sometimes needed for people whose lungs need a larger amount of steroid treatment right away.^1,2

Oral steroids that are used to treat people with COPD include:

• Prelone^® (prednisolone)
• Deltasone^® (prednisone)
• Medrol^® (methylprednisolone)

Bronchodilator-corticosteroid combination medicines

Bronchodilators are medicines commonly used to treat COPD symptoms. Because of the swelling in the airways, the band of muscles surrounding the airways can tighten up. This causes the airway to become too narrow for enough air to pass through to the lungs. Bronchodilators work by relaxing the band of muscles and widening the airways.^1,2

Bronchodilator-corticosteroid combination medicines contain a long-lasting bronchodilator plus a corticosteroid in each inhaled dose. For some people in later stages of the disease, this can be a convenient and effective way to manage COPD symptoms.^1,2 Some of these combination therapies include:

• Advair^® Diskus (salmeterol + fluticasone propionate)
• Breo Ellipta^® (vilanterol + fluticasone furoate)
• Dulera^® (mometasone furoate + formoterol fumarate)
• Symbicort^® (budesonide + formoterol fumarate)

Possible side effects of corticosteroids

The side effects that people have when taking corticosteroids usually depends on:

• The dose they are taking
• The length of time they are taking corticosteroids
• Whether they are taking the corticosteroids through an inhaler or orally in a pill or tablet or liquid²

Common side effects of inhaled corticosteroids are:

• Sore mouth
• Hoarse voice
• Throat and mouth infections
• Slightly higher risk of getting pneumonia²

Most of these side effects can be reduced, or even prevented, by rinsing the mouth thoroughly after each use of the inhaler.²

Side effects from oral corticosteroids are more common and can be more serious. The side effects linked to oral steroids occur more frequently when the steroids are taken in high doses or in smaller doses over a longer period of time. These side effects can include:

• Insomnia
• Stomach irritation
• Skin bruising
• Weight gain
• Osteoporosis
• High blood sugar/diabetes
• Cataracts
• Swelling of the ankles or feet
• Muscle weakness²