How often do you monitor for (1) systemic or (2) local adverse events? When asked to rate the overall safety of ICS on a scale of 1 (very safe) to 6 (dangerous), 25% of participants in this meeting rated ICS as very safe, most (40%) chose 2 on the scale, and 35% chose 3 or […]

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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 […]

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The 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 […]

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The only other systemic side effect with ICS mentioned in the NAEPP 1997 guidelines was disseminated varicella infection. While oral corticosteroid use, with or without immunosuppression, has been associated with a high risk of severe varicella infection compared with case-matched control sub-jects, no causal relationship has been shown with ICS, despite sporadic case reports of […]

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Oral corticosteroids are a known risk factor for the development of subcapsular cataracts, with risk influenced by daily cumulative dose, age, and ethnic origin. The systematic review described above concluded that the risk of cataracts due to ICS was small and may only be relevant in elderly patients. Two studies not included in the systematic […]

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While safety data have been reported for many clinical trials, there are few studies that have been adequately powered, or have long enough follow-up periods, to assess long-term systemic side effects with ICS. A systematic review conducted in collaboration between the American College of Chest Physicians, the American Academy of Allergy, Asthma, and Immunology, and […]

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Modern delivery systems, such as HFA-based pMDI inhalers, enhance drug targeting to the lungs. Thus, lower ICS doses can be used, such that the clinical response is maintained but systemic exposure reduced. For example, conversion from CFC to HFA as a propellant moved the dose-response curve for drugs delivered using the HFA device toward the […]

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