title: Systemic effects of inhaled corticosteroids.
abstract: OBJECTIVE
  Although inhaled corticosteroids (ICSs) are the mainstay of therapy in asthma, their use raises certain safety concerns. We review the articles appearing in the last year which have addressed the safety of ICSs when used in the treatment of asthma and chronic obstructive pulmonary disease (COPD).
  
  
  RESULTS
  Recent studies suggest that patients with asthma as opposed to COPD do not experience an excess risk of pneumonia with ICS use. Patients with respiratory diseases are at increased risk of developing active tuberculosis and this excess risk is exacerbated by the use of high doses of ICSs. ICSs have systemic effects and one result appears to be an increase in the risk of diabetes onset and progression, especially at high doses of ICSs. When examining cases of glaucoma requiring therapy, there was no increase in risk with ICSs even at high current and cumulative doses. Finally, use of even high doses of ICSs during pregnancy does not appear to affect foetal adrenal function.
  
  
  CONCLUSIONS
  ICSs are a highly effective therapy in asthma and have an excellent safety profile at the low doses usually required in asthma. Adverse effects appear mostly at higher doses.
authors: Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, 3755 Côte-Ste.-Catherine, Montreal, Quebec, Canada. pierre.ernst@mcgill.ca
authors: Pierre
authors: P
authors: Ernst
authors: Samy
authors: S
authors: Suissa
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000139:chemically induced; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D005901:Glaucoma / Q000139:chemically induced; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000139:chemically induced; D011247:Pregnancy; D011248:Pregnancy Complications / Q000139:chemically induced; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D014376:Tuberculosis / Q000139:chemically induced
chemical_list: D000305:Adrenal Cortex Hormones