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Side Effects With Inhaled Corticosteroids

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Side Effects With Inhaled CorticosteroidsInhaled corticosteroids (ICS) are the cornerstone of asthma management and result in improved symptom control and quality of life for many patients. However, as for all medicines, the physician must achieve a balance between the potential benefits for the patient and the risk of side effects. For ICS therapy, the potential side effects may be local in the oropharyngeal cavity, or systemic due to absorption of ICS into the circulation through the lungs and GI tract. Increasing the dose of ICS in order to achieve improvements in asthma symptoms, or prolonged treatment over many years, will expose patients to an increased risk of side effects. http://cheap-asthma-inhalers.com/

Despite the publication of guidelines2’ stressing the importance of ICS, ICS are often underused. The major reason that physicians fail to prescribe ICS appears to be due to disagreement with recommendations, particularly regarding when the balance lies between their benefits and the risk of complications and side effects. In addition, patients’ fears of ICS may lead to a lack of adherence with prescribed therapy, which may expose them to the unnecessary risk of an asthma exacerbation. Although the nature of local side effects with ICS is fairly well described and understood, the impact of these side effects on patient quality of life and adherence to therapy may be underestimated. However, the most common concerns regarding ICS therapy relate to the potential systemic effects, which are often more serious, long term, and can be difficult to detect and treat.”

The National Asthma Education and Prevention Program (NAEPP) 1997 guidelines for the diagnosis and management of asthma list local side effects with ICS as oral candidiasis, dysphonia, and cough. Oral candidiasis is a common side effect for many adult patients receiving ICS. The reported incidence varies from 0 to 77%, based on how oral candidiasis was defined. Systematic reviews have yielded conflicting information. For example, some reviews have found that fluticasone propionate (FP), but not budesonide (BUD), was associated with an increased risk of candidiasis compared with placebo, and this effect was dose related. However, in a similar review of comparative studies between FP vs BUD or beclomethasone dipropionate (BDP), there was no difference in the risk of oral candidiasis between these agents. Oral candidiasis was more frequent with FP at 880 ^g/d (5.2%) than with ciclesonide (CIC) at 640 ^g/d (0.4%; p < 0.0001). In a study of mometasone furoate (MF) at 200 and 400 ^g bid compared with the BUD inhaler (Turbuhaler; AstraZeneca AB; Sodertalje, Sweden), 400 ^g bid, the incidence of oral candidiasis was not more than 3% in any group. However, at higher doses of MF (800 to 1,600 ^g/d), oral candidiasis has been observed in 20 to 23% of patients.