Steroids for COPD

Uses, Side Effects, Risks

Chronic obstructive pulmonary disease (COPD) is a group of respiratory conditions that cause lung disease. The two main types are emphysema and chronic bronchitis. When you have COPD, your lungs become easily inflamed. The inflammation causes long-term damage and makes it harder to breathe.

Treatments can slow down the progression of COPD and improve quality of life. Systemic steroids are a commonly prescribed treatment for COPD, usually in combination with other medications. They can help successfully control symptoms, but they do have side effects and risks.

Side Effects of Oral Steroids for COPD: Cup of liquid (fluid retention), lungs (pneumonia), adrenal gland (adrenal insufficiency), bone in an arm (osteoporosis), a drop of blood coming from a finger (diabetes)

Verywell / Michela Buttignol

The two most common forms of COPD are emphysema and chronic bronchitis:

  • Emphysema happens when the walls of the alveoli (tiny air sacs) at the end of your bronchial tubes become damaged and stiff. Your lungs have a harder time getting oxygen into your blood and removing carbon dioxide from your body.
  • Chronic bronchitis causes your bronchial tubes, which carry air into and out of your lungs, to become swollen. Mucus builds up, making the tubes narrow. Cilia (skinny, hairlike projections) also become damaged and are unable to clear the mucus away.

Smoking causes close to 90% of COPD diagnoses. Other causes include secondhand smoke, air pollution, and workplace dust or fumes. Rarely, a genetic condition in which you do not produce enough of an enzyme called alpha-1 antitrypsin can cause COPD. This enzyme protects your lungs from inflammation.  

COPD has no cure. The most common treatments include:

  • Bronchodilators
  • Systemic steroids (also called corticosteroids)
  • Oxygen therapy
  • Pulmonary rehabilitation

This article will discuss how steroids work, the differences between inhaled and oral steroids for COPD, the treatments prescribed, and side effects.

Recap: What Is COPD?

Chronic obstructive pulmonary disease (COPD) is a lung condition that makes it difficult to breathe due to inflammation. The two most common forms of COPD are emphysema and chronic bronchitis.

Smoking is the primary cause of COPD. In rare cases, a genetic condition in which you don't produce enough of an enzyme can also cause COPD. There is no cure, but treatments can slow down the progression of COPD.

How Do Steroids Work?

When you become sick or injured, your body tries to protect itself with an immune response. Part of this response includes inflammation. Damaged cells release chemicals that cause blood vessels to leak into tissues, which creates swelling.

But an immune response that is too strong or does not stop can damage your body’s tissues and organs. Symptoms of inflammation include redness, swelling, and pain. Systemic steroids work by decreasing those inflammation-promoting chemicals to keep tissue damage to a minimum.

Systemic steroids can be prescribed for other conditions besides COPD. They include:

  • Systemic vasculitis (blood vessel inflammation)
  • Myositis (muscle inflammation)
  • Rheumatoid arthritis (an autoimmune disease that mainly affects the joints)
  • Systemic lupus (an autoimmune disease that causes widespread inflammation and tissue damage)

Bronchodilators are typically the first-line treatment for COPD. If symptoms are severe, your healthcare professional may add systemic steroids to your treatment plan. Patients can be given steroids through injection (into muscles or veins), orally (in pill form), or by means of an inhaler.

What Is a Corticosteroid?

Corticosteroids, or systemic steroids, are anti-inflammatory drugs. They are very similar to cortisol, a hormone that your body makes. Cortisol plays a role in the body's immune and stress responses. It also helps regulate blood pressure and blood sugar.

Inhaled Steroids vs. Oral Steroids

For COPD, systemic steroids are taken in combination with other treatments. Usage will usually be temporary to stop an exacerbation (severe flare-up) of symptoms.

Studies show that inhaled steroids reduce bronchial inflammation but do not show a consistent improvement in lung function. Results are best when combined with bronchodilators.

Common inhaled steroids include:

Oral systemic steroids are potent anti-inflammatories. Symptoms are quickly relieved, but healthcare providers will usually avoid prescribing oral steroids long term. Side effects can include infections, venous thromboembolism (blood clots in the veins), diabetes, high blood pressure, and osteoporosis (weakened bones).

Common oral corticosteroids are:

  • Prednisone
  • Cortisone
  • Methylprednisolone
  • Dexamethasone

Generally, inhaled steroid treatment is prescribed long term. Oral steroids might be prescribed for a course of a few days to weeks.

Your healthcare provider will decide what type of steroid is best for you and how long you will take it. They will also need to monitor your progress carefully. The risk of side effects increases the longer you take them.

Types of Steroids Prescribed

There are many different steroids. Some, such as inhalers, are combined with bronchodilators in one medication. Here is a longer list of the kinds of steroids prescribed. Some are steroids alone, and others are steroids combined with bronchodilators:

  • Qvar (beclomethasone)
  • Pulmicort (budesonide)
  • Alvesco (ciclesonide)
  • Flovent (fluticasone)
  • Asmanex (mometasone)
  • Symbicort (budesonide with formoterol, a combination medicine)
  • Advair (gluticasone with salmeterol, a combination medicine)
  • Combivent Respimat (ipratropium with albuterol, a combination medicine)
  • Dulera (mometasone with formoterol, combination medicine)

Side Effects of Systemic (Oral) Steroids

While steroids improve COPD symptoms, they can have side effects. Some can be serious. The risk of side effects depends on the dosage, type of steroid prescribed, and how long you take them.

Common side effects can include:

  • Edema: Also known as fluid retention, edema happens when extra fluid stays in your body. The result is puffiness in the face or other parts of your body. Edema itself is not necessarily dangerous but usually has an underlying cause (such as steroid use).
  • Pneumonia: This is an infection in which fluid gets trapped in your lungs. Because steroids lessen inflammation, it also decreases your immune response. This means your body will have a harder time fighting off infections, increasing your risk of pneumonia. Pneumonia can be serious in older adults, young children, and people with weakened immune systems.
  • Addison's disease (adrenal insufficiency): This develops when your adrenal glands do not make enough hormones, including cortisol. This condition makes it difficult for your body to regulate blood pressure. Adrenal insufficiency can be fatal if not treated.
  • Osteoporosis: Your bones become weak, increasing your risk of fractures or breaks.
  • Diabetes: Steroids cause blood sugar to rise. This can worsen already present diabetes or cause the onset of this disease.

Serious Risks

Intraocular pressure, or increased fluid in the eye, can happen for those with eye conditions such as glaucoma (conditions that cause damage to the optic nerve). This can result in detachment of the retina and cause blindness. Mood changes are another side effect of steroid medications. This can increase your risk of having suicidal thoughts.

Suicide Risk

If you're on steroid treatment and begin to experience suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. Talk with your healthcare provider immediately about adjusting medications.

Summary

Systemic steroids can be a part of a successful treatment plan for COPD. They are strong anti-inflammatories that help ease symptoms. This significantly improves quality of life for those with COPD. Steroids can come in many forms, but inhalers or oral medications are usually prescribed for COPD.

However, systemic steroids do have risks. If taken for an extended time, they can cause uncomfortable side effects, some of which are serious. Side effects include edema (fluid retention), a higher risk of infection, adrenal insufficiency, osteoporosis (weakened bones), diabetes, and mood changes. Your healthcare provider will decide what medications are best to include in your treatment plan.

A Word From Verywell

Managing chronic lung conditions like COPD can be challenging. You may feel overwhelmed and confused at times, especially when you experience a COPD exacerbation. But you can live a fulfilling, active life if you follow a treatment plan that works for you.

When treatment includes steroids, monitor your progress. It is also important to get both the emotional and physical support you need. If you ever feel that something isn’t working or side effects get out of control, speak with your healthcare provider immediately.

Frequently Asked Questions

  • Are there risks associated with long-term steroid use?

    The risks associated with long-term use of steroids include edema (fluid retention), osteoporosis (weakened bones), adrenal fatigue, worsening or onset of diabetes, and mood changes.

  • What are some other treatments for COPD?

    In addition to steroids, other treatment options for COPD include bronchodilators, pulmonary rehabilitation, and oxygen therapy. If medications do not improve symptoms, surgery can repair damaged lung tissue. A lung transplant may also be considered.

  • Can I mix steroids with NSAIDs?

    There are no contraindications for (no reasons not to use) steroids and NSAIDs, nonsteroidal anti-inflammatory drugs, such as Advil or Motrin (ibuprofen) or Aleve (naproxen). But because they are both anti-inflammatory medications, you should consult with your healthcare provider before taking any NSAIDs while on steroid treatment.

16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cleveland Clinic. Chronic obstructive pulmonary disease (COPD). Updated May 18, 2020.

  2. Cleveland Clinic. Corticosteroids. Updated January 20, 2020.

  3. Cleveland Clinic. Emphysema. Updated August 7, 2019.

  4. Centers for Disease Control and Prevention. Chronic obstructive pulmonary disease (COPD). Updated June 9, 2021.

  5. MedlinePlus. COPD. Updated October, 5, 2021.

  6. MedlinePlus. Immune response. Updated October 8, 2021.

  7. National Institutes of Health. COPD. Updated November 3, 2021.

  8. MedlinePlus. Cortisol test. Updated July 31, 2020.

  9. American Lung Association. Managing your COPD medications. Updated March 5, 2021.

  10. Tashkin DP, Strange C. Inhaled corticosteroids for chronic obstructive pulmonary disease: what is their role in therapy? Int J Chron Obstruct Pulmon Dis. 2018;13:2587-2601. doi:10.2147/COPD.S172240

  11. Cleveland Clinic. Treating the inflammation of asthma. Updated March 23, 2021.

  12. Waljee AK, Rogers MAM, Lin P, et al. Short term use of oral corticosteroids and related harms among adults in the United States: population-based cohort studyBMJ. 2017;357:j1415. doi: 10.1136/bmj.j1415 

  13. Cleveland Clinic. Combination agents for COPD. Updated September 14, 2018.

  14. MedlinePlus. Pneumonia. Updated September 15, 2021.

  15. MedlinePlus. Addison disease. Updated August 17, 2021.

  16. MedlinePlus. Naproxen. Updated October 25, 2021.

By Carisa Brewster
Carisa D. Brewster is a freelance journalist with over 20 years of experience writing for newspapers, magazines, and digital publications. She specializes in science and healthcare content.