OBJECTIVES: Oral glucocorticoids (GC) are critical anti-inflammatory agents, yet increase the risk for osteoporosis, myopathy, hyperglycemia, and hypertension. The management of respiratory disease (asthma and chronic obstructive pulmonary disease [COPD]) with oral GCs has changed over time, with an aim to reduce oral GC exposure and preference for inhaled GCs and bronchodilators. We describe changes in prescribing patterns of chronic oral GCs over time among older adults with respiratory disease. METHODS: We identified community-dwelling adults, aged 66+ years with respiratory disease initiating chronic oral GC therapy in Ontario using healthcare claims data, 1998/01-2012/12. Chronic oral GC use was defined as ≥ 450 mg prednisone equivalent and ≥ 2 prescriptions over a 6-month period. Oral GC duration and cumulative dose, dispensing of inhaled GCs and bronchodilators, and hospitalization and emergency visits due to respiratory diseases were described by calendar year. Spline regressions were used to describe quarterly trends in oral GC utilization. RESULTS: We identified 54,399 chronic oral GC users with respiratory disease (14% asthma, 43% COPD, 43% both). Despite restricting our population to patients with a minimum exposure of 450 mg prednisone equivalent, we observed a downward linear trend over time, representing a reduction of 48% in the median days of exposure to GC from 1998 to 2012 (58 days [IQR:93] in 1998 to 30 days [IQR:63] in 2012), and 18% (linear trend) reduction in the GC cumulative dose (median 1080 mg [IQR:1250] to 875 mg [IQR:1110]). No significant decrease of age/sex-adjusted rates of hospitalization and emergency visit were observed over time. CONCLUSIONS: Duration of oral GC use among older adults with respiratory disease decreased over time. Temporal change in patient characteristics and comorbidities may affect the use of oral GC. GC side effect profile should be assessed among patients receiving higher GC doses and suffering other comorbidities.