Introduction: Sarcopenia is characterized by two major phenotypic components: low handgrip strength (HGS) and low appendicular lean mass index (ASMI). Oral corticosteroid (OCS) use is an important medication for acute respiratory exacerbations in patients with COPD and asthma. However, the effects of OCS on sarcopenia components in older people are largely unexplored.

Aims: To examine the association between OCS use and HGS or ASMI in the general population and explore interactions with chronic airway diseases.

Methods: From the population-based Rotterdam Study, 5054 participants (age 69.3±8.7; 52% females) were included in the cross-sectional analysis, and 1324 in the longitudinal analysis. Associations between OCS and HGS or ASMI were analyzed using linear regression models adjusted for age, sex, fat%, height, kidney function, smoking and comorbidities.

Results: At baseline, ever OCS users had lower HGS (?=-0.48 [95%CI -0.84; -0.12]), with cumulative dose (?10 OCS prescriptions)-dependent effects (?=-1.25 [95% CI -2.16; -0.33], than never OCS users. COPD ever OCS users, but not asthma, had lower HGS (?=-0.98 [95% CI -1.91; -0.06]) and lower ASMI (?=-0.14 [95% CI -0.27; -0.01]) than never OCS users. After 5.6 years of follow-up in those free of sarcopenia-traits at baseline, COPD ever OCS users had a lower HGS (?=-1.64 [95% CI -287; -0.40]) with dose (?=-3.61 [95% CI -6.55; -0.68]) and duration (?=-1.49 [95%CI -2.86; -0.13])-dependent effects, compared to never OCS users.

Conclusion: OCS use is associated with decline in handgrip strength in individuals with COPD in a cumulative dose-and duration-dependent manner. Routine muscle examination may be necessary for this patient population.