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Adverse effects of inhaled corticosteroids
N A Hanania1, K R Chapman, S Kesten
1Asthma Centre, Toronto Hospital, University of Toronto, Canada.
The American Journal of Medicine
|February 1, 1995
Summary
Inhaled corticosteroids (ICS) are effective for asthma but may have systemic effects. While common side effects are minor, potential long-term impacts like adrenal suppression and bone loss require further investigation.
Area of Science:
- Pulmonology
- Pharmacology
Background:
- Inhaled corticosteroids (ICS) are the primary anti-inflammatory treatment for adult asthma due to their efficacy and safety.
- Prescription rates, dosages, and duration of ICS use are increasing.
- While topical side effects like oral thrush and hoarseness are common and manageable, systemic effects are a growing concern.
Purpose of the Study:
- To review the potential systemic adverse effects of inhaled corticosteroids in asthma patients.
- To evaluate the current evidence regarding systemic effects such as adrenal suppression, bone loss, and growth retardation.
Main Methods:
- Literature review of short-term, cross-sectional, and retrospective studies.
- Analysis of reported biochemical markers and bone density changes.
- Assessment of evidence for skin, ocular, metabolic, and behavioral changes.
Main Results:
- Adrenal function changes noted at high ICS doses (>1,500 mcg/day) require further clinical relevance assessment.
- Biochemical bone turnover markers and reduced bone density observed in some studies, but long-term prospective data are lacking.
- No conclusive evidence of significant growth retardation in children at conventional ICS doses; other reported systemic effects have confounding factors.
Conclusions:
- ICS remain a recommended asthma therapy, but should be used at the lowest effective dose.
- Ongoing research is needed to clarify the clinical significance of potential systemic effects.
- Careful monitoring and individualized treatment plans are essential for patients using ICS.