• Common single-inhaler combinations of both LONG-ACTING ANTICHOLINERGIC/LONG-ACTING
BETA-AGONIST (also termed LABA/LAMA inhalers) include: Stiolto, Anoro, Bevespi,
2. CORTICOSTEROIDS ("steroids")
Corticosteroids relieve tissue "inflammation"; inflammation refers to the processes of swelling
and redness of the inside lining of the airways. There are "systemic steroids" which you take by
mouth, intravenously, or by injection, and, "inhaled steroids" taken via inhaler or nebulizer.
Systemic steroids are commonly used for treatment of acute severe COPD attacks. Common
systemic steroids include: Prednisone, Medrol. Risks of systemic steroids include: high blood
pressure, cataracts, avascular necrosis, skin thinning, fractures, muscle wasting, etc...everything
that makes news headlines these days. The long-term side effects are not commonly
associated with short-term use; however, the long-term side effects tend to prevent systemic
steroid daily use for most patients.
Inhaled Corticosteroids. To date, studies have demonstrated benefit of some inhaled steroids
used alone and in combination with a long-acting bronchodilator limited only to reducing
exacerbation rates (how often severe, acute COPD attacks occur) only among specific
populations of patients with moderate-severe COPD (people with severe airway obstruction on
lung function tests, who ALSO have experienced multiple acute COPD episodes over the previous
12 months which required treatment with either antibiotics or systemic steroids). In reality, less
than 1-in-5 people on current COPD treatment meet these criteria for inhaled steroid
There remains significant controversy regarding the routine use of inhaled steroids in most
people with COPD. The major concern relates to the increased risks for pneumonia occurring
in people who take these medications as preventive therapy. Ask your doctor to review the
current recommendations and your individual risks and benefits of using inhaled steroids.