Patients with chronic obstructive pulmonary disease (COPD) who undergo long-term treatment with inhaled corticosteroids (ICS) face a significantly higher risk of adverse health outcomes, according to a new study published in the Annals of Family Medicine.

The study, led by Dr. Wilson D. Pace of the DARTNet Institute in Aurora, Colorado, analyzed electronic health records of more than 300,000 individuals over the age of 45 with COPD. Researchers examined two patient cohorts: one that had a COPD diagnosis at any time during the study period and another that was newly diagnosed after entering the database. The study compared health outcomes between patients who used ICS for over 24 months versus those with short-term exposure of less than four months.

Findings revealed a significantly higher risk of developing serious health conditions among long-term ICS users. These included type 2 diabetes, cataracts, pneumonia, osteoporosis, and nontraumatic fractures. The study reported a hazard ratio of 2.65 in the first cohort and 2.60 in the newly diagnosed group, indicating more than a twofold increase in risk. The absolute risk difference for newly diagnosed COPD patients was 20.26%, with a number needed to harm (NNH) of just five—meaning for every five patients treated with long-term ICS, one would experience a harmful health event.

The risk of recurrent pneumonia and fractures was also notably higher among long-term ICS users. Patients in both cohorts had an almost threefold increase in pneumonia risk (hazard ratios of 2.88 and 2.85) and a significantly elevated fracture risk (hazard ratios of 1.77 and 1.57).

Given these findings, researchers caution against the indiscriminate use of ICS in COPD patients. "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 wrote.

While the study provides crucial insights into the risks associated with prolonged ICS treatment, it also comes with industry ties. Several authors disclosed financial relationships with pharmaceutical companies, and the research was funded by a grant from Boehringer Ingelheim, a company that produces respiratory medications.

These findings underscore the need for careful evaluation of COPD treatment plans, balancing the benefits of ICS therapy with its potential risks. Clinicians are advised to assess individual patient profiles before recommending long-term use of inhaled corticosteroids.