Inhaled corticosteroids and cataract: prevalence, prevention and management

Oral and topical (ocular) corticosteroids are known to have the potential to cause cataracts, but inhaled corticosteroids have generally been considered to be free of this adverse effect. However, a large epidemiological study has recently found a strong association in adults between use of inhaled corticosteroids and risk of posterior subcapsular cataract, the most serious type of cataract. This is likely to be a causal association as the association was strong (odds ratio of 10 for heavy users of corticosteroids compared with nonusers); in addition, there was a dose-response relationship and the association is biologically plausible. For people with asthma, the benefits of inhaled corticosteroids for management of their respiratory symptoms will be much greater than the risk of cataract. This is particularly true for children, in whom the risk of cataract is extremely low. Nevertheless, the existence of serious adverse effects of inhaled corticosteroids means they should be used for the shortest duration, and in the lowest dose, compatible with effective asthma management.