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Side Effects With Inhaled Corticosteroids: Physician Perception of Side Effects With ICS Therapy

Published in Asthma

A survey of 429 US family physicians and pediatricians in managed-care organizations was conducted by the Pediatric Asthma Care Patient Outcomes Research Team. This survey focused on physicians’ concerns and perceptions. Although 26% of responders thought ICS were very safe and 66% thought they were safe, 47% were at least moderately concerned regarding one or more ICS side effects (Fig 3). Their greatest concern was regarding linear growth retardation in children. This survey predated the Food and Drug Administration requirement to include a warning on ICS labeling regarding linear growth retardation in children.
In a survey of 213 asthma specialists, 80% of whom were allergists/immunologists and 20% were pulmonologists, the aim was to determine the type and frequency of side effects due to ICS seen in their patients (Fig 4). Only 1% of physicians reported that they saw “short stature” in children either occasionally or frequently, and only 15% reported seeing it rarely. The only area of agreement between these two studies was for oral thrush/oropharyngeal symptoms.
There seems to be a disconnect between the level of concern regarding side effects with ICS and the actual frequency of these side effects noted in practice. However, it is likely that the family physicians were more concerned regarding the seriousness of potential side effects, rather than their frequency. canadian health care mall

During the workshop following this presentation, participants were asked a number of questions that they could respond to anonymously using an electronic interactive keypad system. Responses to most of these questions (listed below) are shown in Figure 5.
•    On a scale of 1 to 6, how would you rate ICS safety overall?
•    Which local adverse event is of most concern in your practice?
•    How often do you see:
Oral candidiasis?
Esophageal candidiasis?
Dysphonia/hoarseness?
Pharyngitis?
Cough?
•    Which systemic event is of most concern in your practice?
•    How often do you see:
Issues with bone mineral density?
ICS-related glaucoma or cataracts?
Skin bruising?
Linear growth issues in children?
Adrenal suppression?

Figure-3

Figure 3. Physicians working in managed-care organizations reporting at least moderate concern regarding ICS side effects. Adapted from Finkelstein et al.

Figure-4

Figure 4. Clinical experience of asthma specialists regarding the frequency of side effects with ICS. ACTH = adrenocorticotropic hormone. Adapted from Storms and Theen.

Figure-5

Figure 5. Top: Side effects of ICS of most concern to the asthma experts participating in this meeting (n = 25): local side effects (black bars) and systemic side effects (open bars). Bottom: Asthma experts’ estimation of the frequency of ICS side effects seen in their practices.