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Optimizing Treatment of Elderly COPD Patients: What Role for Inhaled Corticosteroids?

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Abstract

The most recent international documents on the management and therapy of chronic obstructive pulmonary disease (COPD) recommend inhaled corticosteroids (ICS) in addition to long-acting bronchodilators as maintenance treatment for patients at high risk of exacerbations, namely patients with forced expiratory volume in 1 s (FEV1) of <50 % predicted and/or more than one exacerbation per year. However, ICS are widely used in up to 70 % of COPD patients, including those at low risk of exacerbations. In recent years, concerns about the potential adverse effects of this drug category have been raised, and both observational and clinical studies have shown that elderly subjects with COPD treated with ICS are at high risk of developing cataracts and diabetes and more severe and life-threatening conditions such as pneumonia and osteoporotic fractures. Moreover, aging is characterized by memory impairment, decline in muscle strength and body mass impaired coordination, as well as alterations in eyesight and hearing that can impede proper use of devices currently available for ICS administration. Thus, regular use of ICS in more elderly patients with COPD should follow guideline recommendations, be considered with caution, and be based upon carefully weighing up expected benefits with the risk of undesired, adverse effects.

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Acknowledgments

The authors acknowledge the technical support of AIPO ricerche (Milan, Italy) and the English language revision by Doctor Christopher Botteril.

Author information

Authors and Affiliations

  1. Department of Medicine, Section of Geriatrics, University of Verona, Ospedale Maggiore, Piazzale Stefani 1, 37126, Verona, Italy

    Andrea P. Rossi & Mauro Zamboni

  2. Respiratory Rehabilitation ULSS 20 Verona, Piazzale Lambranzi 1, 37100, Verona, Italy

    Erika Zanardi

  3. Pulmonary Unit, University of Verona, A.O.U.I Verona, Verona, Italy

    Andrea Rossi

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Correspondence to Andrea Rossi.

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AR has received consulting fees/honoraria from Novartis and Boehringer Ingelheim and has participated on speakers’ bureaus for Novartis, Boehringer Ingelheim, Chiesi, and AstraZeneca, although these were not relevant to this manuscript. APR, EZ, and MZ have no conflicts of interest to declare. No sources of funding were used to support the writing of this manuscript.

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Rossi, A.P., Zanardi, E., Zamboni, M. et al. Optimizing Treatment of Elderly COPD Patients: What Role for Inhaled Corticosteroids?. Drugs Aging 32, 679–687 (2015). https://doi.org/10.1007/s40266-015-0291-8

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