Inhaled corticosteroids (ICSs) are indicated for the prevention of exacerbations in COPD; however, a significant proportion of patients at low risk of exacerbations are treated with ICSs. We conducted a systematic review including a diversity of types of study designs and safety outcomes with the objective of describing the risk of adverse effects associated with the long-term use of ICSs in patients with COPD.

A total of 90 references corresponding to 83 studies were included, including 26 randomised clinical trials (RCTs), 33 cohort studies, and 24 nested case–control (NCC) studies. Analysis of 19 RCTs showed that exposure to ICSs for ≥1 year increased the risk of pneumonia by 41% (risk ratio 1.41, 95% CI 1.23–1.61). Additionally, cohort and NCC studies showed an association between ICSs and risk of tuberculosis and mycobacterial disease. There was a strong association between ICS use and local disorders such as oral candidiasis and dysphonia. The association between ICSs and the risk of diabetes and fractures was less clear and appeared significant only at high doses of ICSs.

Since most patients with COPD are elderly and with frequent comorbidities, an adequate risk–benefit balance is crucial for the indication of ICSs.

吸入皮质类固醇 (ICS) 用于预防 COPD 恶化；然而，相当一部分急性加重风险较低的患者接受了 ICS 治疗。我们进行了一项系统评价，包括多种类型的研究设计和安全结果，目的是描述与 COPD 患者长期使用 ICS 相关的不良反应风险。

共纳入 90 篇参考文献，对应 83 项研究，包括 26 项随机临床试验 (RCT)、33 项队列研究和 24 项巢式病例对照 (NCC) 研究。对 19 项 RCT 的分析表明，接触 ICSs ≥ 1 年会增加 41% 的肺炎风险（风险比 1.41，95% CI 1.23–1.61）。此外，队列和 NCC 研究表明 ICS 与结核病和分枝杆菌疾病的风险之间存在关联。ICS 的使用与口腔念珠菌病和发音困难等局部疾病之间存在密切关联。ICS 与糖尿病和骨折风险之间的关联不太清楚，并且仅在高剂量 ICS 时才显着。

由于大多数 COPD 患者年龄较大且合并症频繁，因此充分的风险收益平衡对于 ICS 的适应症至关重要。