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Systemic effects of inhaled corticosteroids: an overview
Dhruti Pandya1, Amar Puttanna1, Viswanatha Balagopal2
1Department of Endocrinology, Walsall Manor Hospital, West Midlands, WS2 9PS, UK.
Inhaled corticosteroids (ICS) can cause systemic side effects affecting various body systems, despite being common asthma medications. Lowering ICS dosage and considering newer molecules like ciclesonide may mitigate these risks.
Area of Science:
- Respiratory Medicine
- Pharmacology
Background:
- Inhaled corticosteroids (ICS) are widely used for asthma and obstructive airway diseases.
- While local side effects are known, systemic effects of ICS are less understood.
- Existing evidence primarily comes from retrospective studies.
Purpose of the Study:
- To provide an updated overview of the systemic effects associated with inhaled corticosteroid treatment.
- To highlight potential adverse outcomes beyond localized effects.
- To inform clinical practice regarding ICS use.
Main Methods:
- Review of retrospective studies and existing literature on ICS systemic effects.
- Analysis of documented impacts on various physiological systems.
- Comparison of systemic effect profiles between different ICS molecules.
Main Results:
- ICS can impact the hypothalamo-pituitary-adrenal axis, bone density, growth, eyes, skin, and immunity.
- Increased risk of pneumonia is associated with ICS use.
- Fluticasone may have a higher likelihood of systemic effects than budesonide; ciclesonide may offer benefits.
Conclusions:
- Systemic effects of ICS are a significant consideration in long-term respiratory management.
- Clinicians should use the lowest effective ICS dose to minimize systemic risks.
- Emerging ICS molecules may offer improved safety profiles regarding systemic complications.
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