Steroids for COPD: Uses, Side Effects, Risks

Chronic Obstructive Pulmonary Disease (COPD) is a group of respiratory conditions that cause lung disease. The two main types are emphysema and chronic bronchitis. When you have COPD, your lungs easily become inflamed. Inflammation causes long-term damage and makes it harder to breathe.

Treatments can slow the progression of COPD and improve quality of life. Systemic steroids are a commonly prescribed treatment for COPD, usually in combination with other medications. They can help successfully control symptoms, but they come with side effects and risks.

The two most common forms of COPD are emphysema and chronic bronchitis:

• Emphysema occurs when the walls of the alveoli (small air sacs) at the end of your bronchial tubes are damaged and stiff. Your lungs have a harder time getting oxygen into your blood and removing carbon dioxide from your body.
• chronic bronchitis causes your bronchi, which carry air in and out of your lungs, to swell. Mucus builds up, making the tubes narrow. The cilia (thin hair-like projections) are also damaged and are unable to clear mucus.

Smoking causes nearly 90% of COPD diagnoses. Other causes include second-hand smoke, air pollution, and workplace dust or fumes. Rarely, a genetic condition in which you don’t produce enough of an enzyme called alpha-1 antitrypsin can cause COPD. This enzyme protects your lungs from inflammation.

COPD has no cure. The most common treatments include:

• Bronchodilators
• Systemic steroids (also called corticosteroids)
• Oxygen therapy
• Pulmonary rehabilitation

This article will discuss how steroids work, the differences between inhaled and oral steroids for COPD, prescribed treatments, and side effects.

How do steroids work?

When you get sick or injured, your body tries to protect itself with an immune response. Part of this response includes inflammation. Damaged cells release chemicals that cause blood vessels to leak into the tissues, creating swelling.

But an immune response that’s too strong or won’t stop can damage your body’s tissues and organs. Symptoms of inflammation include redness, swelling, and pain. Systemic steroids work by decreasing these inflammation-promoting chemicals to minimize tissue damage.

Systemic steroids may be prescribed for other conditions besides COPD. They include:

• Systemic vasculitis (inflammation of blood vessels)
• Myositis (muscle inflammation)
• Rheumatoid arthritis (an autoimmune disease that mainly affects the joints)
• Systemic lupus (an autoimmune disease that causes widespread inflammation and tissue damage)

Bronchodilators are usually the first-line treatment for COPD. If symptoms are severe, your healthcare professional may add systemic steroids to your treatment plan. Patients can receive steroids by injection (into the muscles or veins), by mouth (as a pill), or by means of an inhaler.

Inhaled Steroids vs Oral Steroids

For COPD, systemic steroids are taken in combination with other treatments. Use will generally be temporary to stop an exacerbation (severe flare-up) of symptoms.

Studies show that inhaled steroids reduce bronchial inflammation but do not show consistent improvement in lung function. Results are best when combined with bronchodilators.

Common inhaled steroids include:

Oral systemic steroids are potent anti-inflammatories. Symptoms are quickly relieved, but medical professionals generally avoid prescribing long-term oral steroids. Side effects can include infections, venous thromboembolism (blood clots in the veins), diabetes, high blood pressure and osteoporosis (weakened bones).

Common oral corticosteroids are:

• Prednisone
• Cortisone
• Methylprednisolone
• Dexamethasone

Generally, treatment with inhaled steroids is prescribed for the long term. Oral steroids can be prescribed for a course of a few days to a few weeks.

Your health care provider will decide which type of steroid is best for you and how long you will take it. They will also need to carefully monitor your progress. The risk of side effects increases the longer you take them.

Types of Steroids Prescribed

There are many different steroids. Some, like inhalers, are combined with bronchodilators in one medication. Here is a longer list of the types of steroids prescribed. Some are steroids alone, and others are steroids combined with bronchodilators:

• Qvar (beclomethasone)
• Pulmicort (budesonide)
• Alvesco (ciclesonide)
• Flovent (fluticasone)
• Asmanex (mometasone)
• Symbicort (budesonide with formoterol, a combination drug)
• Advair (gluticasone with salmeterol, a combination drug)
• Combivent Respimat (ipratropium with albuterol, a combination medicine)
• Dulera (mometasone with formoterol, combination drug)

Side effects of systemic (oral) steroids

Although steroids improve COPD symptoms, they can have side effects. Some can be serious. The risk of side effects depends on the dosage, the type of steroid prescribed, and how long you take them.

Common side effects can include:

• Edema: Also known as water retention, edema occurs when excess fluid remains in your body. The result is puffiness on your face or other parts of your body. Edema itself is not necessarily dangerous but usually has an underlying cause (such as steroid use).
• Pneumonia: This is an infection in which fluid is trapped in your lungs. Because steroids decrease inflammation, they also decrease your immune response. This means your body will have a harder time fighting infections, increasing your risk of pneumonia. Pneumonia can be serious in the elderly, young children, and people with weakened immune systems.
• Addison’s disease (adrenal insufficiency): This develops when your adrenal glands do not produce enough hormones, including cortisol. This condition makes it difficult for your body to regulate blood pressure. Adrenal insufficiency can be fatal if left untreated.
• Osteoporosis: Your bones become weaker, which increases your risk of fractures or fractures.
• Diabetes: Steroids raise blood sugar. This can aggravate existing diabetes or cause the onset of this disease.

Serious risks

Intraocular pressure, or increased fluid in the eye, can occur in people with eye conditions such as glaucoma (conditions that damage the optic nerve). This can lead to retinal detachment and lead to blindness. Mood changes are another side effect of steroid medications. This can increase your risk of having suicidal thoughts.

Summary

Systemic steroids can be part of a successful treatment plan for COPD. They are powerful anti-inflammatories that help relieve symptoms. This significantly improves the quality of life for people with COPD. Steroids can take many forms, but inhalers or oral medications are usually prescribed for COPD.

However, systemic steroids pose risks. If taken for a prolonged period, they can cause unpleasant side effects, some of which are serious. Side effects include edema (fluid retention), increased risk of infection, adrenal insufficiency, osteoporosis (weakened bones), diabetes, and mood changes. Your health care provider will decide which medications are best to include in your treatment plan.

A word from Verywell

Managing chronic lung conditions like COPD can be difficult. You may feel overwhelmed and confused at times, especially when experiencing an exacerbation of COPD. But you can lead an active and fulfilling life if you follow a treatment plan that’s right for you.

When treatment includes steroids, monitor your progress. It’s also important to get the emotional and physical support you need. If you feel like something isn’t working or side effects are getting out of hand, talk to your healthcare provider right away.