title: Meta-review: adverse effects of inhaled corticosteroids relevant to older patients.
abstract: BACKGROUND
  In recent years, clinical trials and observational studies have raised concerns about the potential adverse effects of inhaled corticosteroids (ICS) such as pneumonia, cataract, fractures and hyperglycaemia, which are of particular concern for older patients.
  
  
  METHODS
  We conducted a meta-review by searching electronic databases (MEDLINE, EMBASE, PubMed) for systematic reviews and meta-analyses of ICS use and the adverse effects of interest. We also evaluated new primary studies that reported information beyond that available from previously published meta-analyses. Two reviewers independently extracted data on measures of associated harm with ICS use.
  
  
  RESULTS
  We identified five relevant meta-analyses for inclusion in this meta-review, and also three new studies of ICS and pneumonia. We found consistent evidence of a dose-response relationship between ICS use and serious adverse effects such as fractures and pneumonia. The estimated number needed to treat for harm due to fracture with ICS was 83 with 3-years use, and 60 per year for pneumonia. Both asthma and chronic obstructive pulmonary disease (COPD) users of ICS were at risk of pneumonia, with fluticasone appearing to confer higher risk than budesonide. There is also some suggestion that ICS use is associated with cataracts in a dose-response manner but the evidence is less robust here. Equally, the influence of ICS on diabetes mellitus remains uncertain.
  
  
  CONCLUSIONS
  In view of the dose-response relationship seen between ICS use and important adverse effects such as fractures and pneumonia, clinicians needs to carefully balance the benefits of ICS versus the harms in older patients receiving long-term high-dose ICS.
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
authors.forename: Katharina
authors.initials: K
authors.lastname: Mattishent
authors.forename: Menaka
authors.initials: M
authors.lastname: Thavarajah
authors.forename: Patricia
authors.initials: P
authors.lastname: Blanco
authors.forename: Daniel
authors.initials: D
authors.lastname: Gilbert
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Wilson
authors.forename: Yoon K
authors.initials: YK
authors.lastname: Loke
mesh_terms: D000280:Administration, Inhalation; D000367:Age Factors; D000368:Aged; D002386:Cataract / Q000139:chemically induced / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D050723:Fractures, Bone / Q000139:chemically induced* / Q000453:epidemiology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000453:epidemiology; D011014:Pneumonia / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids