Article

Side effects with inhaled corticosteroids: the physician's perception.

Pulmonary, Allergy and Critical Care Medicine Division, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA.
Chest (impact factor: 5.25). 08/2006; 130(1 Suppl):41S-53S. DOI:10.1378/chest.130.1_suppl.41S pp.41S-53S
Source: PubMed

ABSTRACT The National Asthma Education and Prevention Program 1997 guidelines and 2002 update provide an overview of potential local and systemic side effects associated with inhaled corticosteroids (ICS) and suggest ways of minimizing the risk of these side effects occurring. Despite the guidelines and extensive clinical experience of the safe use of ICS, a significant number of physicians retain concerns regarding side effects. Local side effects may lead to patients discontinuing therapy, with or without the knowledge of their physicians. In particular, concerns regarding systemic side effects, such as growth retardation in children and osteoporosis, remain relatively widespread. Pharmacokinetic studies reveal that different ICS compounds and formulations result in different degrees of systemic bioavailability, indicating possible differences in their potential to cause systemic side effects. However, clinical studies that can be used to differentiate between ICS formulations are generally lacking. Consequently, there is a need to continue to further our understanding of side effects with ICS, with the aim of identifying formulations, devices, and doses with an optimal risk/benefit ratio. The introduction of new agents with potentially improved safety profiles may reassure physicians and patients as to the relative benefits of ICS therapy in asthma.

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    Article: Evaluation impact of long-term usage of inhaled fluticasone propionate on ocular functions in children with asthma.
    Ozkaya Emin, Mete Fatih, Ozsutcü Mustafa, Samanci Nedim, Cekiç Osman
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    ABSTRACT: Although systemic, topical, and periocular corticosteroid administration have long been associated with ocular side effects, there has been little evidence to suggest that long-term inhaled corticosteroids can cause ocular side effects. The aim of this study was to evaluate the effects of long term treatment inhaled fluticasone propionate spray usage the recommended dose on some ocular functions in pediatric patients with asthma. The study group consisted of 266 prepubertal children with asthma who had used inhaled fluticasone propionate spray at 3-6 years intermittently. One hundred and sixty children who were newly diagnosed with asthma without any treatment made up the control group. Schirmer test results, central corneal thickness, visual acuity, intraocular pressure, cataract formation, keratometry and tear break-up time compared between study and control groups. The ages of the 266 study patients (150 male) were between 7 and 11 years. The average age (±SEM) was 8.2±1.7 years, and the mean (±SEM) a daily dose of 323 μg (range 250-450 μg) inhaled fluticasone propionate spray, with 865.2±215 g total steroid use during treatment. Eye functions including cataract formation, corneal ectasia, ocular hypertension or glaucoma, and dry eye were not observed in any of the patients in the study group and were not correlated with total steroid dosage (t=0.150, p=0.384). Our findings suggest that long-term intermittent treatment for 3-6 years with inhaled fluticasone propionate spray, as much as average 320 μg daily, in children with asthma seems to be safe for some eye functions.
    Steroids 02/2011; 76(6):548-52. · 2.83 Impact Factor
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Keywords

asthma
 
cause systemic side effects
 
different degrees
 
different ICS compounds
 
formulations result
 
ICS formulations
 
ICS therapy
 
inhaled corticosteroids
 
Local side effects
 
National Asthma Education
 
new agents
 
optimal risk/benefit ratio
 
patients discontinuing therapy
 
potential local
 
Prevention Program 1997 guidelines
 
relative benefits
 
safety profiles
 
significant number
 
systemic bioavailability
 
systemic side effects