Pros and Cons of Glucocorticoids

Do the benefits outweigh the risks?

Man using inhaler outside

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If you have COPD, your doctor may have prescribed glucocorticoids (also known as corticosteroids, or steroids) as part of your treatment plan. While glucocorticoids do have many benefits, they also have serious risks and side effects which you should be aware of.

According to the Global Initiative for Obstructive Lung Disease (GOLD), the role that oral and inhaled glucocorticoids play in the treatment of stable COPD is rather controversial and limited to certain instances.

How Do Glucocorticoids Work?

As they pertain to COPD, glucocorticoids work by decreasing swelling and inflammation in the airways of the lungs.

Pros and Cons of Inhaled Glucocorticoids

Regular treatment with inhaled glucocorticoids has been shown to reduce the frequency of COPD exacerbation and improve health status in patients with Stage III (severe) to Stage IV (very severe) COPD. However, their use does not stop the decline of forced expiratory volume (FEV1) or reduce the mortality rate associated with COPD. In addition, withdrawal from inhaled glucocorticoids can lead to COPD exacerbation in some patients and increase the likelihood of developing pneumonia.

In light of this information, treatment with inhaled glucocorticoids is not indicated in patients with stable COPD, but may be recommended for patients in more advanced stages of COPD and is standard for COPD exacerbation.

Commonly inhaled glucocorticoids include the following:

  • Beclomethasone
  • Triamcinolone
  • Fluticasone
  • Flunisolide

Combination Therapy

Using an inhaled glucocorticosteroid that is combined with a long-acting beta-agonist has been shown to reduce the frequency of COPD exacerbation, improve lung function and overall health status in patients with COPD, but again, may also increase the likelihood of pneumonia.

Oral Glucocorticoids

There are many existing guidelines that continue to advocate the use of short or long-term oral glucocorticoid therapy in the management of COPD. According to GOLD, however, this practice is not recommended due to a lack of sufficient evidence of benefit and a long list of adverse side effects. To follow are some common oral glucocorticoids that you may be familiar with:

  • Prednisone
  • Dexamethasone
  • Methylprednisolone
  • Cortisone

Side Effects of Glucocorticoids

While the side effects of oral glucocorticoids are numerous and well-documented, adverse effects associated with inhaled glucocorticoids are fewer and less severe. Included below are some commonly known side effects of oral glucocorticoids:

  • Lowered immune system (Immunosuppression)
  • High blood sugar
  • Weight gain
  • Easy bruising
  • Reduced bone density
  • Muscle breakdown, weakness
  • Cataracts
  • Glaucoma
  • Adrenal insufficiency (if used for a long period and stopped suddenly)

Inhaled glucocorticoids are more commonly associated with:

  • Skin bruising
  • Yeast infection of the mouth and pharynx
  • Hoarseness of the voice

Final Words About Glucocorticoids

The most important aspect of any treatment plan is having the willingness to follow it. If you are not able to adhere to your plan of care, your health care provider should try to determine what barriers may be standing in the way. All treatment plans should come with a clear explanation of their purpose and probable outcomes. If your doctor does not provide this information for you, you should clarify it before you leave their office.

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