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Steroids can play a very important role in the treatment of COPD, but they aren't without risks. What should COPD patients know?

While there is no cure for COPD, a wide variety of medications can help you find relief from your symptoms. Bronchodilators may be the first class of medication you'll start taking, but steroids (corticosteroids or glucocorticosteroids) can also play a crucial role in your COPD treatment. Steroids fight inflammation in your lungs and can often liberate you from a state in which you're gasping for air very quickly. 

1. How can steroids benefit COPD patients?

If you have COPD, your airways are going to be inflamed and irritated, leading to shortness of breath. Corticosteroids serve to fight this inflammation. They work by lowering the eosinophils — a kind of white blood cell that unfortunately causes inflammation — in your lungs, which in turn relieves dyspnea. Corticosteroid treatment does not replace bronchodilators, but is rather used as an addition. The two can even be found in the same medication, in which case it's a combination medication. 

2. Will all COPD require steroids?

No. If other medications can effectively control your symptoms, you will not be offered corticosteroids. If you are dealing with a flare-up (exacerbation), you may be prescribed a short-term course of steroids, however, while COPD patients with more severe symptoms may use steroids as a maintenance treatment every day. 

3. What kinds of steroid medications can be employed in the treatment of COPD?

  • Oral steroids are taken by mouth, and can come in pill or liquid form.
  • Inhaled steroids are inhaled. 
  • Combination inhalers deliver a corticosteroid and another medication together in the same dose. 

4. What should COPD patients know about inhaled steroids?

Inhaled steroids are preferable for COPD patients — they send your medication straight to your lungs, not only offering faster relief but also bypassing some of the side effects associated with oral corticosteroids. Typically used as maintenance medications, inhaled steroids for COPD can help reduce the severity of symptoms over the long term. They can also, however, offer fast relief to people with acute symptoms. 

The benefits of inhaled steroids for COPD are that they:

  • Can lead to better lung function
  • Help you prevent COPD exerbations 
  • Make you feel better — leading to a better quality of life
Inhaled steroids can be delivered through both inhalers and nebulizers. Some examples are Qvar (beclomethasone dipropionate HFA), Pulmicort (budesonide), Beclovent (beclomethasone dipropionate), Flovent (fluticasone propionate, and AeroBid (flunisolide).

5. What should COPD patients know about oral corticosteroids?

Oral steroids typically come into play when a patient is facing a moderate to severe COPD exacerbation and needs fast relief. In this case, they are prescribed in higher doses for a short period of time, with the aim of helping you breathe more easily and improving lung function. Because oral steroids can yield long-term side effects, it is important for doctors to apply caution when prescribing them. 

Some of the steroids that can be prescribed orally include:  

  • Deltasone (prednisone)
  • Prelone (prednisolone)
  • Cortef (hydrocortisone)
  • Medrol (methylprednisolone)
  • Dexamethasone Intensol (dexamethasone)

6. What should COPD patients know about combination inhalers that include steroids?

Combination inhalers that offer both a long-acting bronchodilator and corticosteroid in the same "puff" can be extremely convenient. They reduce inflammation and open the airways, resulting in both long- and short-term relief and ultimately a better quality of life. Take your medication exactly as directed, as quitting it suddenly can lead to an immediate worsening of symptoms.

Combination inhalers include:

  • Symbicort (budesonide and formoterol fumarate)
  • Advair Diskus (salmeterol and fluticasone propionate)
  • Combivent Respimat (albuterol and ipratropium bromide)
  • Breo Ellipta (vilanterol and fluticasone furoate)
  • Dulera (mometasone furoate and formoterol fumarate)

7. What about the side effects of steroids? Aren't they scary?

They can be. While steroids can absolutely make your life so much easier, they are also associated with some pretty serious side effects when used over long periods of time. How likely you are to fall victim to these depends on the amount of time you're taking them, your dosage, and the mode of delivery (oral vs inhaled). 

Inhaled corticosteroids lead to a sore mouth, hoarseness, and oral thrush quite easily. This is why it is so important to use them as directed — rinsing your mouth after every dose goes a very long way toward preventing these side effects. Clean your inhaler's mouthpiece, as well. Inhaled steroids have also been linked to a small increase in your risk of developing pneumonia. 

Oral corticosteroids are associated with an abundance of side effects, particularly in people who take them for long periods of time or in high doses. Among them are: 

  • Osteoporosis
  • Involuntary weight gain
  • Ankle and foot swelling
  • Insomnia
  • Irritation of the stomach
  • Easy bruising
  • High blood sugar levels, and eventually diabetes
  • Cataracts
  • Weakness in the muscles

8. Steroids for COPD: Some warnings

It is up to your doctor to prescribe you the medications that will benefit you the most, while taking into account your risk of side effects, other medical conditions you may have, and possible drug interactions that can strike when you combine steroids with other medications. While it's your doctor's responsibility to inform you of the risks and benefits of any medication they prescribe, it's on you to let them know what they need to know.

This includes:

  • Let your doctor know if you use NSAIDs, including over-the-counter ones. Taking these with some steroids, like prednisone, puts patients at risk of stomach ulcers and bleeding. It can even contribute to heart and kidney disease. 
  • If you have an eye disease like glaucoma, steroids should be prescribed with caution, as they can raise intraocular pressure.
  • If you are depressed, suicidal, or have a family history of mental health struggles, some steroids are not suitable for you. Beclomethasone (Qvar) is knowm for instance, to trigger suicidality in some patients.

  • Photo courtesy of SteadyHealth
  • erj.ersjournals.com/content/45/2/525
  •  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4234428/
  •  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014384/
  •  ​https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143733/

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