Related Experiment Videos
Complications of topical steroid therapy for asthma
1Department of Medicine, University of Western Ontario, London, Canada.
Abstract:
The oropharyngeal complications of IS therapy are seldom a serious problem. They may be avoided or ameliorated by inhaling the drug via a spacer and/or reducing the dosing frequency. Severe esophageal candidiasis or atrophic glossitis are rare and generally require discontinuation of IS therapy. Reflex cough or bronchospasm triggered by the inhaled drug occur fairly commonly, but are easily corrected by appropriate treatment. The systemic complications of IS therapy are inconsequential in most patients treated with conventional low doses. Higher doses are more effective but also more active systemically. Despite this, the ratio of systemic-to-antiasthmatic activities may be more favorable with high dose IS than with oral prednisone when the two treatments are compared at equivalent levels of asthma response. The potential risk of adverse systemic effects accruing from the long-term use of intermediate or high doses of IS needs to be rigorously studied.
Insights
Inhaled steroid (IS) therapy for asthma has manageable oropharyngeal side effects, often preventable with spacers. Systemic effects are minimal at low doses, but long-term high-dose risks require further study.
Area of Science:
- Pulmonology
- Pharmacology
- Allergy & Immunology
Background:
- Inhaled steroid (IS) therapy is a cornerstone treatment for persistent asthma.
- Understanding the potential complications of IS is crucial for optimizing patient care and adherence.
- Both oropharyngeal and systemic effects need consideration, especially with varying doses and delivery methods.
Purpose of the Study:
- To comprehensively review the oropharyngeal and systemic complications associated with inhaled steroid (IS) therapy.
- To evaluate the impact of delivery methods (e.g., spacers) and dosing on complication frequency and severity.
- To compare the systemic effects of high-dose IS with oral prednisone in asthma management.
Main Methods:
- Review of existing literature on inhaled steroid (IS) therapy and its associated adverse effects.
- Analysis of complication data related to oropharyngeal and systemic effects.
- Comparative assessment of IS efficacy and safety profiles against oral corticosteroids.
Main Results:
- Oropharyngeal complications of IS therapy are generally minor and manageable, often preventable with spacers or dose adjustments.
- Severe oropharyngeal issues like candidiasis or glossitis are rare and may necessitate treatment cessation.
- Systemic complications are typically inconsequential at low IS doses; higher doses increase systemic activity but may offer a better risk-benefit ratio than oral prednisone for equivalent asthma control.
Conclusions:
- Most oropharyngeal complications of IS therapy can be avoided or mitigated through proper inhaler technique and dosage management.
- Systemic side effects of IS are minimal at conventional doses, but long-term risks of intermediate to high doses warrant further investigation.
- High-dose IS may present a more favorable systemic safety profile compared to oral prednisone at equivalent asthma control levels.