The treatment regimen for patients who have COPD often includes prescriptions for oral or inhaled corticosteroids. Corticosteroids can be prescribed to help manage symptoms that suddenly worsen during a COPD exacerbation or be used on a daily basis to manage the condition long term.
The shortness of breath and coughing associated with COPD happen when an infection or irritation enflames lung airways and clogs them with mucus. Steroids can help reduce that inflammation, open airways, relax muscles, and prevent further lung damage.
Steroids may also be taken every day—through an inhaler or a nebulizer— to help manage ongoing COPD symptoms and reduce the frequency of future flare-ups. During an acute flare-up, a short-term course of oral steroids is often the preferred prescription for quick relief, as it takes inhaled steroids longer to work. Conversely, inhaled steroids are considered more advisable for long term management because the delivery system avoids some of the side effects that are associated with an extended use of oral corticosteroids.
The range of inhaled therapies has expanded dramatically in recent years. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report, there are four phenotypes of inhaled therapy and the type prescribed may depend on the severity of a patient’s condition and the frequency of flare-ups. Patients with persistent symptoms but not so frequent flare ups may be best helped by one therapy, while those who have frequent flare ups but not too many ongoing symptoms may be prescribed another. If patients are not getting the relief they need, they should know there are options.
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Corticosteroids can have side effects. The likelihood of side effects depends on whether the corticosteroids are taken orally or through an inhaler. The dose also matters, as does the length of time the corticosteroids are taken.
Side effects of taking corticosteroids may include: an increased chance of infections, mouth infections, a hoarse voice, a sore mouth or throat, and weakened bones. With inhaled therapies, many of these side effects can be reduced or prevented by rinsing the mouth thoroughly after each use of the inhaler. Pharmacists can help reduce such side effects by explaining the importance of rinsing.
Side effects that are more commonly associated with long-term oral steroid use may include: insomnia and stomach irritation, weight gain, bruising easily, high blood sugar/diabetes, swelling of the ankles or feet, and muscle weakness.
Some recent studies link one current type of inhaled COPD therapy with a higher risk of contracting pneumonia, so it may not be suitable for all COPD patients, but careful screening can help determine the best therapy with the lowest risk. Patients should also be encouraged to report any side effects to their healthcare professional.