OBJECTIVES: The prevalence of COPD in NH residents is 10-20%. While ICS use occurs commonly, there are concerns about adverse consequences of therapy. Our goal was to develop a  profile of NH residents with COPD, and to identify differences in outcome markers in residents receiving ICS vs. those not receiving ICS. METHODS: Pharmacy claims and Minimum Data Set (MDS) 2.0 data from January 1, 2009 to September 30, 2009 and October 1, 2009 to September 3, 2010 were extracted from Omnicare Senior Health Outcomes, then linked and de-identified.  A profile of residents with COPD was developed using descriptive analyses. Residents receiving ICS were matched to residents not receiving ICS on age, gender, tobacco use, and prevalence of diabetes mellitus, respiratory infection, osteoporosis, pneumonia, hip fracture, and “other” fracture.  One year change from baseline within subsets was assessed using Chi-square analyses primarily. Linear logistic regression was used to compare baseline-adjusted outcomes between subsets. RESULTS: Fifty-nine percent of NH residents with COPD had full MDS and pharmacy data available (24,733/41,598).  Of these, 4000 ICS-receiving and 4000 non-ICS-receiving residents were matched. The ICS subset generally showed higher cognition, memory, and functioning (all p=0.001) comparatively. The non-ICS subset demonstrated higher incidence of Alzheimer’s disease, other dementia, and greater cognitive impairment (all p=0.001), while shortness of breath, anxiety, glaucoma, pneumonia, oxygen therapy, and at least 1 hospital stay were more common in the ICS subset (all p<0.05). The 1 year change in ICS subset showed a significant increase in the adjusted odds ratio of “other” fracture (non-hip) when compared to the non-ICS subset {OR 1.44 [1.07, 1.94], p=0.016)}. CONCLUSIONS: Our analysis indicates NH residents with COPD receiving ICS may be at greater risk of non-hip fracture.  Research focusing on a longer-term horizon, duration of ICS treatment, and recommended use of ICS is needed to further understand the consequences of ICS use.