Systemic side effects of inhaled corticosteroids in patients with asthma.When steroid tablets are taken for many months or inhaled steroids side effects long term effects, harmful side effects are likely and almost inevitable. The list of possible effects is long; it includes mood changes, forgetfulness, hair loss, easy bruising, steroid injection for burn scars tendency toward high blood pressure and diabetes, thinning of the bones osteoporosissuppression of the adrenal glands, muscle weakness, weight gain, cataracts, and glaucoma. After being swallowed, these tablets are absorbed from the stomach into the bloodstream and taken not only to the bronchial tubes to treat asthma but also to every other part of the body. Their effects are widespread. On the other hand, only miniscule amounts of steroid medication enter the bloodstream after inhaling it.
Inhaled Corticosteroid Asthma Inhaler for Long-Term Treatment
Inhaled corticosteroids are increasingly being used for the first line management of asthma. Adverse effects such as adrenal suppression and osteoporosis are well documented. Less well recognised adverse effects include glaucoma, skin fragility, acne vulgaris and hirsutism. Be aware of the cumulative effect if co-prescribing various dose forms of corticosteroids such as inhaled, intranasal, oral and topical preparations.
The lowest dose necessary to achieve optimal disease control should always be prescribed. Inhaled corticosteroids have been used in the management of asthma for more than 20 years. Treatment is now being advocated earlier in the course of the disease which has led to a considerable increase in the use of inhaled corticosteroids, particularly at higher dosages.
The adverse effects of topical steroids occur either locally, at the site of action of the drug, or as a result of systemic absorption. Although local adverse effects of inhaled steroids are most common e.
Inhaled steroids are absorbed via the oropharynx, lungs and gut. Absorption which bypasses the gut, and hence does not undergo first-pass metabolism in the liver, has a greater chance of causing systemic adverse effects. Adrenal suppression, osteoporosis, decreased growth in children and behavioural changes are all well recognised dose-dependent adverse effects of inhaled steroids.
Topical ophthalmic steroids can precipitate ocular hypertension and secondary open-angle glaucoma, as can systemic corticosteroids. The mechanism is thought to involve an increase in intraocular pressure by alteration of the resistance to aqueous humour outflow. In these patients it may be advisable to check intraocular pressures. There do not appear to be any reports of glaucoma associated with prolonged continuous use of lower dosages of inhaled steroids.
Skin atrophy is a well recognised adverse effect from both topical and systemic corticosteroids. This atrophy leads to purpura, loss of subcutaneous tissue, and increased skin mobility with consequent fragility and traumatic tearing of the skin.
The degree of cutaneous atrophy is dose related. There are now several reports of skin thinning and purpura in association with long-term inhaled steroids. The authors comment on the confounding factor of some patients having had short courses of systemic steroids. Women appear to be more likely to develop skin bruising. Patients should be encouraged to regularly use moisturisers on their arms and legs, as these may reduce bruising and tearing of the skin from minor trauma.
Sun protection of these areas, either from clothing or the application of a sunscreen, should also be recommended. There are several reports of sudden-onset moderately severe acne vulgaris in patients on inhaled steroids.
This pattern of acne is classical for patients on systemic steroids. Steroid-induced acne does respond to conventional acne treatments but only if the steroid is discontinued.
If the steroid is to be continued, isotretinoin Roaccutane may be indicated. Over the last few years there have been several reports, to the Centre for Adverse Reactions Monitoring CARM and WHO, of patients who have developed hirsutism in association with long-term inhaled steroids. The hirsuties is more marked in female patients who usually note an increase in fine downy hair on the sides of the face, as well as over the upper lip and chin areas. The mechanism of action is likely to be the same as hirsutism associated with oral corticosteroids.
Treatment of this type of hirsuties is unrewarding, particularly if the steroids are to be continued. It is unclear whether the new laser treatments for hair removal will be effective for steroid-induced hirsutism. In these situations, it may be wise to monitor intraocular pressure and promote the use of moisturisers and suncreens.
The aim of this article is to bring less well recognised adverse effects of inhaled corticosteroids to the attention of prescribers.
Whilst inhaled steroids have a more favourable side effect profile than systemic steroids, they are not free from adverse effects. Be particularly aware of the cumulative effect of co-prescribing various dose forms of corticosteroids inhaled, intranasal, oral and topical preparations.
Skin fragility - dose related purpura, bruising and skin thinning reported Skin atrophy is a well recognised adverse effect from both topical and systemic corticosteroids. Acne vulgaris - predominantly truncal and affecting older patients There are several reports of sudden-onset moderately severe acne vulgaris in patients on inhaled steroids.
Hirsutism - risk higher in women and those with prolonged use Over the last few years there have been several reports, to the Centre for Adverse Reactions Monitoring CARM and WHO, of patients who have developed hirsutism in association with long-term inhaled steroids. Conclusion The aim of this article is to bring less well recognised adverse effects of inhaled corticosteroids to the attention of prescribers.
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