Corticosteroids for Chronic Obstructive Pulmonary Disease (COPD)Skip to the navigation
Pill or liquid form (oral)
|Generic Name||Brand Name|
|Generic Name||Brand Name|
Corticosteroid and beta2-agonist combination
|Generic Name||Brand Name|
|budesonide and formoterol||Symbicort|
|fluticasone and salmeterol||Advair|
|vilanterol and fluticasone||Breo Ellipta|
Steroid medicines (corticosteroids) to be inhaled come in a form for a metered-dose inhaler (MDI) or a dry powder inhaler (DPI).
How It Works
Steroid medicines decrease inflammation in the airways (reducing swelling and mucus production), making breathing easier.
Why It Is Used
Inhaled steroid medicines may be used to treat stable symptoms of COPD or symptoms that are slowly getting worse. They may decrease the number of COPD exacerbations in people with severe COPD, particularly those with chronic bronchitis and frequent exacerbations.
These medicines may be useful for people who have asthma as a component of their disease.
How Well It Works
Research results on oral steroid medicines for COPD exacerbations show that:
- They improve lung function, reduce the amount of time in the hospital, and reduce the incidence of treatment failure (return to the hospital, death, or the need for a tube inserted through the mouth or nose and into the chest to deliver oxygen [endotracheal intubation]).footnote 1
Research on inhaled steroid medicines:
- Suggests that for some people they reduce the frequency of COPD exacerbations compared to a placebo.footnote 2, footnote 3
- Reports conflicting results on whether they improve lung function.footnote 3, footnote 4
Your doctor may prescribe more than one type of medicine to help you. For example, using an inhaled steroid medicine with a long-acting beta2-agonist has been shown to result in:
- Improved lung function and improved shortness of breath and less use of relief medicine compared to a placebo and compared to either medicine used alone.footnote 5, footnote 6
- Fewer COPD exacerbations compared to a placebo.footnote 5, footnote 3
Combining a steroid medicine with a beta2-agonist and an anticholinergic improved:footnote 7
- Lung function.
- Quality of life.
- The number of hospital visits.
It is not possible to predict who will improve with steroid medicine. Lung function tests (spirometry) can be done before and after using the medicine, to learn if it has helped.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
The possibility of side effects increases as the dose of the medicine increases. Side effects are less likely to occur when you use the inhaled form of the medicine.
Oral corticosteroids (short-term use)
Common side effects of oral steroid medicines include:
- Weight gain and fluid retention.
- Loss of muscle mass.
- Mood changes.
- High blood pressure.
Oral steroid medicines also may increase blood sugar level, which may lead to a type of diabetes caused by the medicine (secondary diabetes). If you already have diabetes, it may make the diabetes harder to control.
Oral corticosteroids (long-term use)
Common side effects of long-term use of oral steroid medicines include:
- Osteoporosis (loss of bone).
- Recurrent infections.
- A cloudy area in the lens of the eye (cataracts).
- Thin, fragile skin that bruises easily.
- Increased risk for sores in the stomach (ulcers).
Common side effects of inhaled steroid medicines include:
- Sore mouth or sore throat.
- Voice changes, such as hoarseness.
- Growth of a fungus in the mouth, throat, or esophagus (thrush). This usually occurs only at high doses.
The U.S. Food and Drug Administration (FDA) has reported that salmeterol may make breathing more difficult. If your wheezing gets worse after taking salmeterol, call your doctor right away.
Using a device called a spacer with your metered-dose inhaler and rinsing your mouth with water and spitting the water out after inhaling should reduce these side effects.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
The inhaled form of steroid medicines are preferred to the oral form for long-term treatment of COPD, because they cause fewer side effects. But low-dose inhaled steroid medicines do not always work as well as high-dose oral steroid medicines.
Long-term treatment with oral steroid medicines is not recommended. Although long-term treatment with inhaled steroid medicines reduces the frequency of COPD exacerbations in some people, the long-term risks and whether the benefit is worth the risks of long-term treatment is not known.footnote 2
Most doctors recommend that everyone using an inhaler also use a spacer. Use of a spacer is especially important when using an inhaler containing a steroid medicine. But you should not use a spacer with a dry powder inhaler (DPI).
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breastfeeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breastfeeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Singh JM, et al. (2002). Corticosteroid therapy for patients with acute exacerbations of chronic obstructive pulmonary disease. Archives of Internal Medicine, 162: 2527–2536.
- Alsaeedi A, et al. (2002). The effects of inhaled corticosteroids in chronic obstructive pulmonary disease: A systematic review of randomized placebo-controlled trials. American Journal of Medicine, 113: 59–65.
- McIvor RA, et al. (2011). COPD, search date April 2010. Online version of BMJ Clinical Evidence: http://www.clinical evidence.com.
- Highland KB, et al. (2003). Long-term effects of inhaled corticosteroids on FEV1 in patients with chronic obstructive pulmonary disease. Annals of Internal Medicine, 138: 969–973.
- Calverley P, et al. (2003). Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: A randomised controlled trial. Lancet, 361: 449–456.
- Hanania NA, et al. (2003). The efficacy and safety of fluticasone propionate (250 micrograms)/salmeterol (50 micrograms) combined in the Diskus Inhaler for the treatment of COPD. Chest, 124: 834–843.
- Aaron SD, et al. (2007). Tiotropium in combination with placebo, salmeterol, or fluticasone-salmeterol for treatment of chronic obstructive pulmonary disease. Annals of Internal Medicine, 146(8): 545–555.
Current as of: August 21, 2015
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