For patients with chronic obstructive pulmonary disorder (COPD), long-term inhaled corticosteroid (ICS) treatment is associated with increased rates of adverse composite and specific individual outcomes, according to a study published in the March/April issue of the Annals of Family Medicine.

Wilson D. Pace, M.D., from DARTNet Institute in Aurora, Colorado, and colleagues examined electronic health record data for individuals older than 45 years with COPD to assess long-term ICS risks. The prevalent cohort had a COPD diagnosis any time during the observation period (318,385 individuals), and the inception cohort had a COPD diagnosis after entry into the database (209,062 individuals).

A composite outcome of any new diagnosis of type 2 diabetes, cataracts, pneumonia, osteoporosis, or nontraumatic fracture and recurrent event outcomes of repeated pneumonia or nontraumatic fracture were compared for long- versus short-term ICS exposure (>24 months versus <4 months).

The researchers found that the composite dichotomous outcome was significantly greater for long- versus short-term ICS use for both the prevalent and inception cohorts (hazard ratios, 2.65 and 2.60, respectively). The absolute risk difference of the composite outcome was 20.26% for the inception cohort, with a number needed to harm of five.

For recurrent pneumonia and recurrent fracture, the hazard ratios were significantly increased in the prevalent and inception cohorts (hazard ratios, 2.88 and 2.85 for pneumonia, respectively; 1.77 and 1.57 for fracture, respectively).

“The clinical use of and indications for ICS therapy in COPD should be carefully considered for each individual before initiation of long-term ICS therapy,” the authors write.

Several authors disclosed ties to the pharmaceutical industry, and the study was funded by a research grant from Boehringer Ingelheim.

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