Table 3.

Relationship Between COPD Comorbidities and ICS Treatment

Concomitant Condition	ICS Treatment		Ref
COPD	S	If response to bronchodilator treatment is insufficient, adding ICS may be considered if blood eosinophil counts ≥300 cells/µL or ≥ 100 cells/µL in COPD patients with ≥2 moderate exacerbations* or ≥1 exacerbation requiring hospitalization. Initiation therapy with LABA/ICS may be the first choice in selected COPD patients (symptomatic with frequent exacerbations and blood eosinophil counts ≥ 300 cells/µL). A follow-up treatment in combination with LAMA and/or LABA, in selected patients	[13]
Asthma	R	LABA/ICS may be first choice in COPD patients with a history of asthma and asthma-COPD overlap	[13]
Pneumonia	C	Regular treatment with ICS increases the risk of pneumonia, particularly in patients with severe COPD. De-escalation of ICS must be considered.	[13]
Osteoporosis/fractures	C	ICS have been associated with increased bone loss and fracture risk. Consideration in women.	[61–63]
Diabetes and pre-diabetes	C	ICS, particularly high doses, have been associated with onset and progression of diabetes.	[65,66]
Bronchiectasis	C	ICS may not be indicated in patients with bacterial colonization or recurrent lower respiratory tract infections.	[13,84]
Mycobacterial infection (including tuberculosis)	C	ICS, particularly high doses, were shown to increase the risk of tuberculosis.	[71]

Notes: *Moderate exacerbation: defined as exacerbation treated with short-acting bronchodilators plus antibiotics and/or oral corticosteroids.¹³

, Recommended (green); , Selected patients (yellow); , Caution (red).

Abbreviations: COPD, chronic obstructive pulmonary disease; ICS, inhaled corticosteroid; LABA, long-acting β₂-agonist; LAMA, long-acting antimuscarinic.