Inhaled corticosteroids for chronic obstructive pulmonary disease

Expert Opin Pharmacother. 2013 Dec;14(18):2489-99. doi: 10.1517/14656566.2013.848856. Epub 2013 Oct 21.


Introduction: Current guidelines recommend the use of inhaled long-acting bronchodilators, inhaled corticosteroids (ICSs) and their combinations for maintenance treatment of moderate-to-severe chronic obstructive pulmonary disease (COPD); however, it is questionable whether all COPD patients should be treated, as the long-term use of ICSs is accompanied by side effects.

Areas covered: This article reviews the evidence about the effects of ICSs in the treatment of COPD. It mainly focuses on meta-analyses of published data and pooled analyses of primary data. It also offers an overview of pipeline developments.

Expert opinion: There is now more evidence that there are subsets of patients (mainly, frequent exacerbators with predominant chronic bronchitis and those with overlap between COPD and asthma) with a favorable response to treatment with ICSs (i.e., reduced progression of lung function loss, reduced exacerbation rate and improved health-related quality of life). Therefore, nowadays, the right question is not whether ICSs should not be used at all unless patients have concomitant asthma, but, instead, which COPD patient can benefit from a therapy with ICSs. Unfortunately, however, the number of studies that have investigated the clinical features that might predict corticosteroid response in COPD is still inadequate.

Publication types

  • Review

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / adverse effects
  • Adrenal Cortex Hormones / therapeutic use*
  • Bronchodilator Agents / administration & dosage
  • Bronchodilator Agents / therapeutic use
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Humans
  • Lung / drug effects*
  • Practice Guidelines as Topic
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / mortality
  • Quality of Life
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Bronchodilator Agents