Systemic Effects of Inhaled Corticosteroids: An Overview

Abstract

Inhaled corticosteroids (ICS) are common medications, used in respiratory medicine for controlling conditions such as asthma and other obstructive airway diseases. The systemic effects of oral corticosteroids are well known and established; inhaled steroids have been known to cause relatively minor and localized adverse effects such as oral candidiasis. However, less attention has been paid to their systemic effects. Although currently there is a paucity of prospective studies demonstrating the systemic effects of inhaled corticosteroids, there are numerous retrospective studies adding evidence to this link. Inhaled corticosteroids can affect the hypothalamo-pituitary-adrenal axis, bone density and growth, eyes, skin and immunity including an increased risk of pneumonia. Clinicians are recommended to aim for the lowest possible dose to avoid these systemic side effects. Fluticasone is more likely to cause systemic effects compared to budesonide. Newer ICS molecules such as ciclesonide may be more beneficial in reducing such systemic complications on prolonged use. This paper provides an updated overview of the common systemic effects encountered with ICS treatment.

Oral corticosteroids for asthma exacerbations might be associated with adrenal suppression: Are physicians aware of that?

“…23 The Canadian Society of Allergy and Clinical Immunology recommends screening for AS in children receiving high-dose ICS based on morning serum cortisol level. 18 The current recommendation is to use the lowest effective dose of ICS to maximize the benefit-risk ratio, 19 but some children will really need high-dose ICS to control asthma symptoms. Among available high-dose ICS drugs and devices, both inhaled beclomethasone dipropionate and fluticasone propionate have a bigger effect on the HPA axis than budesonide due to metabolic issues.…”

Benefit of Preoperative Oral Steroids during Sinus Surgery when Utilizing Concentrated Topical Epinephrine

“…While steroids remain a mainstay of treatment for CRS, their side effects including suppression of the hypothalamo-pituitary-adrenal axis, avascular necrosis, cataracts, and glaucoma have prompted multiple investigations to limit their systemic use [15,16]. To minimize the systemic absorption of corticosteroids, many clinicians have adopted the use of high-volume topical steroid irrigations.…”

Emerging corticosteroid agonists for the treatment of asthma

“…There are no important differences in adverse effect profile. However, there is a small variation in systemic bioavailability between the drugs (Table 1) [11].…”

“…In addition, the dose requirement of ICS is much lower than that of OCS. However, high doses of ICS are enough to influence the hypothalamo-pituitaryadrenal axis [10,11], indicating systemically absorbed doses of steroids with physiological impact. Long-term adverse effects of oral steroid treatment include serious manifestations such as osteoporosis, hyperglycemia, arterial hypertension, weight gain, skin thinning, glaucoma, peptic ulceration and psychiatric disorders [12].…”