The Use of Inhaled Corticosteroids for Patients with COPD Who Continue to Smoke Cigarettes: An Evaluation of Current Practice

Ian M. Adcock, Surya P. Bhatt, Ronald Balkissoon, Robert A. Wise

Research output: Contribution to journalReview articlepeer-review

Abstract

The use of inhaled corticosteroids (ICS) in combination with inhaled bronchodilators for patients with chronic obstructive pulmonary disease (COPD) is a common practice in primary care settings. However, ICS-containing therapies may be less effective in patients with COPD compared with asthma, and in individuals with COPD who continue to smoke cigarettes. Preclinical studies suggest that inflammation in COPD is very different from in asthma. Glucocorticoid receptor functioning and other innate anti-inflammatory mechanisms are altered in cells exposed to cigarette smoke. COPD may be relatively insensitive to ICS, especially in individuals who continue to smoke. ICS-containing therapies in patients with asthma who continue to smoke may also be less effective compared with patients who do not smoke. ICS-containing therapies may be inappropriately used in some patients with COPD, and their long-term use is associated with an increased risk for side effects, including pneumonia and bone fractures in some patients. Treatment for patients with COPD should be carefully evaluated, and anti-inflammatory/bronchodilatory strategies should be chosen based on individual patient characteristics and recommendations in current guidelines.

Original languageEnglish (US)
Pages (from-to)302-312
Number of pages11
JournalAmerican Journal of Medicine
Volume135
Issue number3
DOIs
StatePublished - Mar 2022

Keywords

  • COPD
  • Corticosteroid
  • Corticosteroid insensitivity
  • Corticosteroid resistance
  • Glucocorticoid receptor
  • HDAC2
  • Inhaled corticosteroid

ASJC Scopus subject areas

  • General Medicine

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