Inhaled Steroids for COPD

Medically Reviewed by Carmelita Swiner, MD on December 03, 2022
3 min read

If you have COPD, your doctor may prescribe inhaled corticosteroids as part of your treatment. Steroids can help control inflammation and swelling in your airways. If you have problems with shortness of breath or wheezing, they can ease these symptoms, too.

You can breathe in steroids a couple of different ways:

  • Inhaler: A handheld device that sprays the medication directly into your mouth while you breathe in.
  • Nebulizer: A machine that turns the medicine into a fine mist that you breathe in.

Examples of inhaled corticosteroids include:

Inhaled steroids aren’t the go-to treatment for COPD, so your doctor will likely prescribe a bronchodilator, too. This is medicine in an inhaler that relaxes your airway muscles to help you breathe more easily. The doctor may prescribe one of each kind or a combination inhaler that has a corticosteroid plus one or more bronchodilators.

Combination inhalers include:

Overall, inhaled steroids can reduce exacerbations (periods when your symptoms get worse for days or weeks) and help slow down worsening COPD symptoms.

If you have asthma too, an inhaled steroid can help treat the symptoms of both conditions.

For people with moderate to severe COPD who also have exacerbations, studies show that a long-acting bronchodilator used along with inhaled steroids works better than just one or the other. Together, they can improve your lung function, lower the number of exacerbations, and boost your overall health.

Inhaled steroids usually have few or no side effects as long as you use them as directed. Possible side effects include:

Along with the effects mentioned above, combination inhalers could have these side effects:

  • Dizziness
  • Headache
  • Cramps
  • Wheezing
  • Nervousness
  • Tremor
  • Fast heartbeat
  • Increased blood pressure
  • Increased risk of infection
  • Upset stomach

Inhaled steroids have fewer and far less serious side effects than oral steroids. But there’s still room for concern. You use inhaled steroids for a long period of time. Your chances of more serious side effects go up the longer you’re on high doses of inhaled steroids. Plus doctors often prescribe them to babies, young children, and older adults. They can cause increased appetite, weak or thin bones (osteoporosis), infections, bruising, and slower growth in kids.

Long-term inhaled steroid use also raises your risk of pneumonia, especially if your COPD is severe.

You can lower your chances of thrush by rinsing your mouth and gargling with water after using your inhaler. Be sure to spit it out.

This type of medication isn’t meant to stop an attack, so talk to your doctor about which inhaler to use for quick relief.

Inhaled steroids aren’t a good choice if you’ve ever had tuberculosis, you’ve had repeated episodes of pneumonia, or if your eosinophil count -- a type of white blood cell -- is too low.

In some people, inhaled steroids may cause increased pressure in the eye (the doctor will call this ocular hypertension) and speed up cataracts. We need more studies to know how serious this potential risk is.

There’s some debate over whether or not inhaled steroids are a good treatment for stable COPD, especially since bronchodilators have more benefits and fewer side effects. Because of this, doctors usually start COPD patients with bronchodilators and other treatments like education and exercise programs before they prescribe inhaled steroids.