Safety of inhaled corticosteroids in the treatment of persistent asthma.
OBJECTIVE
Inhaled corticosteroids (ICSs) are the most effective medications available for patients with persistent asthma of all severities and currently are recommended as the preferred asthma controller therapy by the National Heart, Lung and Blood Institute. Nevertheless, lingering concerns about potential adverse systemic effects of ICSs contribute to their underuse. This review discusses the safety of ICSs with respect to potential systemic effects of most concern to physicians and patients.


METHODS
Articles reporting on the safety of ICSs in children and adults with persistent asthma were identified from the Medline database from January 1966 through December 2003, reference lists of review articles and international respiratory meetings.


RESULTS
Ocular effects of ICSs and ICS effects on bone mineral density and adrenal function are minimal in patients maintained on recommended ICS doses. One-year growth studies in children have shown decreased growth velocity with ICSs, but long-term studies with inhaled budesonide and beclomethasone show no effect on final adult height, suggesting that these effects are transient. In addition, extensive data from the Swedish Medical Birth Registry show no increased risk of adverse perinatal outcomes when inhaled budesonide is administered to pregnant women with asthma.


CONCLUSIONS
ICSs have minimal systemic effects in most patients when taken at recommended doses. The benefits of ICS therapy clearly outweigh the risks of uncontrolled asthma, and ICSs should be prescribed routinely as first-line therapy for children and adults with persistent disease.
Peters
Stephen P
SP
Wake Forest University Health Sciences, Center for Human Genomics, Winston-Salem, NC 27157, USA. sppeters@wfubmc.edu
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D015519:Bone Density / Q000187:drug effects; D002386:Cataract / Q000139:chemically induced; D002908:Chronic Disease; D005260:Female; D005901:Glaucoma / Q000139:chemically induced; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D009798:Ocular Hypertension / Q000139:chemically induced; D010913:Pituitary-Adrenal System / Q000187:drug effects; D011247:Pregnancy; D011248:Pregnancy Complications; D018570:Risk Assessment
D000305:Adrenal Cortex Hormones