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Side Effects With Inhaled Corticosteroids: Systemic Side Effects

Published in Asthma

Side Effects With Inhaled Corticosteroids: Systemic Side EffectsThe only specific recommendation for monitoring systemic side effects made in the NAEPP 1997 guidelines was to monitor growth in children. However, based on the evidence available at the time, the guidelines recommended the following measures for minimizing potential systemic side effects with ICS: Here

• Use a spacer device and rinse the mouth after inhalation. Selroos and Halme demonstrated that systemic absorption of ICS was reduced by using a spacing device with a metered-dose inhaler after using a DPI.
•    Use the lowest possible dose of ICS to maintain control. In children, step down ICS dose whenever possible.
•    Add additional therapies (long-acting (32-agonist) before increasing the ICS dose.
•    In postmenopausal women, consider calcium supplements (1,000 to 1,500 mg/d) and vitamin D (400 IU/d). Estrogen replacement therapy, when appropriate, may be considered for patients receiving ICS doses > 1,000 ^g/d. This recommendation is no longer up to date (see next paragraph).
Varicella vaccination was not included in the recommendations for patients receiving ICS.
Since these guidelines were published, the recommendations have changed for postmenopausal women. While it is reasonable to recommend that women consume the recommended daily amounts of vitamin D and calcium in diet and supplements, the literature suggests that calcium and vitamin D supplementation by themselves are insufficient to prevent fractures in postmenopausal women.’ Also, publication of the Women’s Health Initiative Estrogen Plus Progestin Trial on the risk/benefit profile of hormone replacement therapy has resulted in this no longer being indicated for routine use in postmenopausal women as a viable intervention for primary prevention of chronic diseases. Optimization of other steroid-sparing strategies has also been suggested, such as control of smoke and allergen exposure, influenza vaccination, and treatment of rhinitis, sinusitis, and gastroesophageal reflux disease when present. In patients with osteoporosis, additional therapy with agents that have been shown to decrease the risk of fractures such as antiresorptive drugs is indicated.