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

Am J Med. 2022 Mar;135(3):302-312. doi: 10.1016/j.amjmed.2021.09.006. Epub 2021 Oct 14.

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.

Keywords: COPD; Corticosteroid; Corticosteroid insensitivity; Corticosteroid resistance; Glucocorticoid receptor; HDAC2; Inhaled corticosteroid.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma* / drug therapy
  • Bronchodilator Agents / therapeutic use
  • Cigarette Smoking*
  • Drug Therapy, Combination
  • Humans
  • Pulmonary Disease, Chronic Obstructive* / complications

Substances

  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Bronchodilator Agents