By Amanda Gardner
WEDNESDAY, Oct. 29 (HealthDayNews) — Three new studies have found a slight increased risk or almost no increased risk of fractures in people with chronic obstructive pulmonary disease (COPD) who take inhaled corticosteroids.
The findings, all preliminary, were presented Oct. 29 at the American College of Chest Physicians meeting in Orlando, Fla.
Inhaled corticosteroids are most often used to treat asthma patients, and so the bulk of the research to date has been conducted in that population, says Kourtney Davis, an epidemiologist at GlaxoSmithKline who was involved in all three of the studies. GlaxoSmithKline manufactures the inhaled corticosteroid fluticasone propionate (sold under the brand names Flonase and Flovent) and funded all three of the studies.
Some evidence has suggested inhaled corticosteroids can affect bone mineral density in asthmatics, Davis adds, but no one knows what the effects might be in the COPD population. People with COPD have different risk factors for fracture. “They’re less active, smoke, they’re older, and there has been concern that they might be more at risk,” Davis explains.
There has also been some controversy over whether the drugs are effective for COPD, which refers to chronic lung disorders involving blocked air flow in the lungs. The two main disorders within this category are emphysema and chronic bronchitis.
The first study looked at 1,708 veterans with COPD who had had non-vertebral fractures (meaning not in their spine) and compared them with 6,817 vets who had COPD but no fractures.
Individuals with COPD who were using high doses of inhaled corticosteroids had a slight increase in the risk of nonvertebral fractures compared to COPD patients who had never used the drugs.
“It was not a huge risk, but when you start talking about several tens of thousands or hundreds of thousands of people, it adds up,” says study author Todd Lee, a senior investigator at the Hines VA Hospital in Chicago.
The findings are not enough reason to stop using inhaled corticosteroids if you have COPD, but may be reason to go for the smallest dose possible, the study authors say.
According to Dr. Paul Mayo, director of the medical intensive care unit at Beth Israel Medical Center in New York City, small and moderate doses tend to be more effective than larger ones anyway.
The authors of the second study, which was led by Davis, looked at more than 48,000 people in Britain with COPD. Of that total, the study authors zeroed in on 2,808 people who had had non-vertebral fractures within 12 months of diagnosis and compared them with 8,453 individuals with COPD but no fractures.
Again, there was a slightly increased risk of non-vertebral fractures associated with the recent use of two inhaled steroids, beclomethasone (BDP, which GlaxoSmithKline also makes) and budesonide. People who had taken GlaxoSmithKline’s fluticasone propionate (FP) did not have an elevated risk. Davis warns, however, that not too much should be made of this finding as FP is a relatively new drug and was not available for the entire time being studied. Also, all of the drugs were taken off-label, indicating this group of patients might have been sicker than the average.
Yet a third study looked at 89,877 members of a managed care organization who had COPD or asthma, then compared 1,722 individuals who had received treatment for a non-vertebral fracture with 17,220 controls who had not experienced a fracture. In this case, there appeared to be no significant fracture risk in using the inhaled corticosteroids.
“[The studies are] saying don’t worry about using them, but we would suggest using a lower dose if you can,” Mayo says.
“If [inhaled corticosteroids] are effective [in people with COPD], I don’t think the risk of fracture outweighs the benefit that you might get, but I think it is important to be aware that there is that risk of fracture,” Lee says. “If we are going to be using them in older patients with COPD, we need to be cognizant. We don’t want to push them over the edge.”